Fabiani M, Mateo-Urdiales A, Andrianou X, Bella A, Del Manso M, Bellino S, Rota MC, Boros S, Vescio MF, D'Ancona FP, Siddu A, Punzo O, Filia A, Brusaferro S, Rezza G, Dente MG, Declich S, Pezzotti P, Riccardo F, group Cw, ,
Eur J Public Health - (-) - [2021-01-08; online 2021-01-08]
International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers, and refugees. We analysed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case-fatality and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. We analysed 213,180 COVID-19 cases, including 15,974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalised [(adjusted rate ratio (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44)] and admitted to ICU (ARR = 1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower HDI. We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR = 1.32, 95% CI: 1.01-1.75). A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.