Quality of evidence: C-
Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy
Authors: Onder G et al
Journal: JAMA
Objectives: Unveil the reasons for high CFR in Italy
Strength of evidence: Low (short communication, not a systematic review, hypothesis/position paper)
Methods/publication type: Short narrative review (communication/correspondence, 5 articles included)
Highlights :
Death rate = 7.2% in mid-March
Higher than China because of more old people in Italy (23% of the population > 65 years old)
38% of those infected> 70 (vs 23% in China)
99% of Italian patients presented comorbidities (average of 2.7 pre-existing comorbidities) - NB: patients not hospitalized not reported
In a specific cohort of Italian non-survivors (age, 79.5 years, 70% male), 30% had ischemic heart disease, 35.5% had diabetes, 20.3% had active cancer, 24.5% had atrial fibrillation, 6.8% had dementia, and 9.6% had a history of stroke.
Differences in data/reporting between China and the WHO (death of people above 90 not included for the Chinese government) and differences vs Italy that reports death based on postmortem qPCR of Covid-19 RNA, while China takes into account comorbidities leading to underestimation (e.g. death by heart attack of a Covid-19 patient might not be considered cause by Covid-19)
The diagnostic tests are performed only for severe patients distorting the calculus (numerous cases not diagnosed or reported)
China underestimates its death toll while Italy overestimates it
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