Socioeconomic inequalities in overall and COVID-19 mortality during the first outbreak peak in Emilia-Romagna Region (Northern Italy)

OBJECTIVES: to provide a description of inequalities in overall and COVID-19 mortality by ecological socioeconomic measures (ESEMs) during the first outbreak peak (March and April 2020) in Emilia-Romagna Region. DESIGN: cross-sectional study based on the record linkage of the COVID-19 notification system, the regional population health register and the 2011 census data. SETTING AND PARTICIPANTS: residents in Emilia-Romagna who were grouped according to three ESEMs calculated at census block level: the index of deprivation, the household crowding, and the percentage of the foreign resident population. MAIN OUTCOME MEASURES: counts of all deaths and those directly attributable to COVID-19. The association between mortality and ESEMs was assessed through rate differences and mortality rate ratios, estimated through Poisson models. RESULTS: during the outbreak peak, the nine provinces of the Emilia-Romagna Region were unequally hit by the COVID-19 outbreak, with Piacenza recording the highest COVID-19 absolute death toll and Ferrara the lowest. The overall and COVID-19 mortality burden was unequal also in terms of ecological socioeconomic measures. Percentage differences in the age-standardised mortality rates between the least and the most disadvantaged census blocks were greater for COVID-19 mortality than for overall mortality, suggesting that the Coronavirus outbreak has had a stronger impact on the most socioeconomically deprived areas. Although clear gradients were not always present, people living in the most disadvantaged census blocks experienced the highest absolute and relative risk of dying. Rate differences were larger among men, but mortality rate ratios were not always greater among men than women, especially for the COVID-19 mortality. CONCLUSIONS: these descriptive yet informative results are relevant to document inequalities and inform regional public health policies and interventions in case of new COVID-19 surges.