Impact of the COVID-19 Pandemic on Total and Cause-Specific Mortality in Pavia, Northern Italy

The COVID-19 pandemic had an unfavorable impact on overall mortality in Italy, with the strongest consequences in northern Italy. Scant data are available on cause-specific mortality. This study aims at investigating the impact of the pandemic on the overall and cause-specific mortality in one province in northern Italy, Pavia. We linked individual-level administrative data (i.e., death certification and population data) from the Health Protection Agency (HPA) in Pavia province between 2015 and 2020. We computed age-standardized mortality rates (Italian population 2011) by cause, sex, and calendar year, and computed the rate ratio and the corresponding 95% confidence intervals to compare rates in 2020 versus 2015-2019. The 2020 excess total mortality in Pavia was 24% in men and 25% in women, reaching rates of 1272.6/100,000 and 1304.4/100,000, respectively. Significant excesses were found for infectious and parasitic diseases, excluding COVID-19 (about +30% in both sexes); respiratory system diseases (44% in men; 30% in women); and dementia and Alzheimer's disease among men (24%). Reductions were reported for neoplasms (-14% in men); cerebrovascular diseases (-25% in men); and ischemic diseases (-13% in women), but also for transport accidents in men. COVID-19 was the third cause of death in both sexes with rates of 274.9/100,000 men (859 total deaths) and 213.9/100,000 women (758 total deaths). Excess mortality in Pavia was higher than Italy but lower than Lombardy. Increases in mortality from causes related to infectious and respiratory diseases can likely be explained by underdiagnosed deaths from COVID-19.