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Background: Italy experienced a sustained excess in total mortality between March 2020 and December 2022, resulting in approximately 226,000 excess deaths. This study extends the estimate of excess mortality in the country until June 2023, evaluating the persistence of excess mortality., Methods: We used mortality and population data from 2011 to 2019 to establish a baseline for expected deaths during the pandemic. Over-dispersed Poisson regression models were employed, stratified by sex, to predict expected deaths. These models included calendar year, age group, and a smoothed function for the day of the year as predictors. Excess mortality was then calculated for all ages and working ages (25-64 years)., Results: From January to June 2023, we found a reduction in the number of deaths compared to the expected ones: 6,933 fewer deaths across all age groups and 1,768 fewer deaths in the working age category. This corresponds to a 2.1% and 5.2% decrease in mortality, respectively., Conclusions: The excess mortality observed in Italy from March to December 2022 was no longer observed in the first six months of 2023.

Background: Italy had a persistent excess of total mortality up to July 2022. This study provides updated estimates of excess mortality in Italy until February 2023., Methods: Mortality and population data from 2011 to 2019 were used to estimate the number of expected deaths during the pandemic. Expected deaths were obtained using over-dispersed Poisson regression models, fitted separately for men and women, including calendar year, age group, and a smoothed function of the day of the year as predictors. The excess deaths were then obtained by calculating the difference between observed and expected deaths and were computed at all ages and working ages (25-64 years)., Results: We estimated 26,647 excess deaths for all ages and 1248 for working ages from August to December 2022, resulting in a percent excess mortality of 10.2% and 4.7%, respectively. No excess mortality was detected in January and February 2023., Conclusions: Our study indicates substantial excess mortality beyond those directly attributed to COVID-19 during the BA.4 and BA.5 Omicron wave in the latter half of 2022. This excess could be attributed to additional factors, such as the heatwave during the summer of 2022 and the early onset of the influenza season.

Background: The impact of new lineages and sub-lineages of Omicron on total and excess mortality is largely unknown. This study aims to provide estimates of excess mortality during the circulation of the Omicron variant in Italy updated to July 2022., Methods: Over-dispersed Poisson regression models, fitted separately for men and women, on 2011-2019 mortality data were used to estimate the expected number of deaths during the Covid-19 pandemic. The excess deaths were then obtained by the difference between observed and expected deaths and computed at all ages and at working ages (25-64 years)., Results: Between April and June 2022, we estimated 9,631 excess deaths (+6.3%) at all ages (4,400 in April, 3,369 in May, 1,862 in June) and 12,090 in July 2022 (+23.4%). At working ages, the excess was 763 (+4.9%) in April-June 2022 and 679 (+13.0%) in July 2022., Conclusions: Excess total mortality persisted during the circulation of different lineages and sub-lineages of the Omicron variant in Italy. This excess was not limited to the elderly population but involved also working age individuals, though the absolute number of deaths was small. The substantial excess found in July 2022 is, however, largely attributable to high temperatures. At the end of the year, this may translate into 30 to 35,000 excess deaths, i.e. over 5% excess mortality. This reversed the long-term trend toward increasing life expectancy, with the relative implications in social security and retirement schemes.

Background: This study provides updated estimates of the excess deaths in Italy with a focus on the working-age population., Methods: Over-dispersed Poisson regression models, fitted on 2011-2019 mortality data, and including terms for age, calendar year and a smooth function of the week of the year, were used to estimate the expected number of deaths during the Covid-19 pandemic. The excess deaths were then obtained by the difference between observed and expected deaths and reported according to the pandemic periods defined by the predominant circulating variant of SARS-CoV-2., Results: Around 170,700 excess deaths at all ages were estimated between March 2020 and March 2022 in Italy with most of the excess occurring during the pre-Delta and Delta period, and 2930 excess deaths (+2.5%) during the Omicron wave. The excesses among the working age population were: 10,425 deaths (+11.8%) during the pre-Delta period, 2460 (+9.4%) during the Delta wave, 283 (+2.2%) during the transition period to Delta. Mortality was lower than expected during the Omicron wave (-6.1%)., Conclusions: Over the periods preceding the Omicron wave, Covid-19 caused around 12,800 excess deaths among individuals of working age, accounting for over 10% excess death. This excess was no longer observed during the Omicron wave.

Background: New releases of daily mortality data are available in Italy; the last containing data up to 31 January 2022. This study revises previous estimates of the excess mortality in Italy during the Covid-19 pandemic., Methods: Excess mortality was estimated as the difference between the number of registered deaths and the expected deaths. Expected deaths in March-December 2020, January-December 2021 and January 2022 were estimated separately by sex, through an over-dispersed Poisson regression model using mortality and population data for the period 2011-2019. The models included terms for calendar year, age group, a smooth function of week of the year and the natural logarithm of the population as offset term., Results: We estimated 99,334 excess deaths (+18.8%) between March and December 2020, 61,808 deaths (+9.5%) in 2021 and 4143 deaths (+6.1%) in January 2022. Over the whole pandemic period, 13,039 excess deaths (+10.2%) were estimated in the age group 25-64 years with most of the excess observed among men [10,025 deaths (+12.6%) among men and 3014 deaths (+6.3%) among women]., Conclusions: Up to 31 January 2022, over 165 thousand excess deaths were estimated in Italy, of these about 8% occurred among the working age population. Despite high vaccination uptake, excess mortality is still observed in recent months.

Background: Vaccine hesitancy is the main barrier to the effective management of COVID-19. This study aims to evaluate attitudes towards vaccination and containment measures in Italy, and the role of occupational physicians in the management of COVID-19., Methods: Between 26 and 31 January 2022, we conducted a national online survey including 1000 respondents (631 workers) representative of the Italian population. A series of questions were asked to get information on attitudes towards COVID-19 vaccination, containment measures and management of COVID-19. Sampling weights were used to obtain national estimates., Results: The majority of respondents (92.6%) received at least two doses of SARS-CoV-2 vaccine (or one dose of Janssen, Ad26.COV2.S), only 4.9% did not get any dose. Most interviewees (79.2%) stated that the decision to be vaccinated was their own choice, while only 4.3% were convinced by the general practitioner or the occupational physician. History of SARS-CoV-2 infection was reported by 23.9% of the participants (30.2% among workers); and 40% of the infected workers were contacted/visited by an occupational physician., Conclusions: Vaccine uptake was remarkably high in Italy. Occupational physicians played a relevant role in the management of COVID-19 in occupational settings.

Background: Italy was severely hit by the Covid-19 pandemic with an excess of around 90,000 total deaths in 2020. Comparable data in 2021 are needed for monitoring the effects of the interventions adopted to control its spread and reduce the burden. This study estimates the excess mortality in Italy in the first eight months of 2021, with a focus on the working age population., Methods: Excess mortality was estimated as difference between the number of registered deaths and the expected deaths. Expected deaths in March-December 2020 and January-August 2021 were estimated separately by sex, through an over-dispersed Poisson regression model using mortality and population data for the period 2011-2019 (before the Covid-19 outbreak). The models included terms for calendar year, age group, a smooth function of week of the year and the natural logarithm of the population as offset term.  Results: In the first eight months of 2021, we estimated 34,599 excess deaths (+7.9% of the expected deaths), of these 3667 were among individuals of working age (25-64 years). In this age group, mortality was 8.2% higher than expected with higher excesses among men (2972 deaths, +10.7%) than women (695 deaths, +4.1%)., Conclusions: The excess deaths in the first eight months of 2021 account for about one third of that registered in 2020. Current data indicate that around 5000 excess deaths are expected by the end of the year, leading to a total excess for 2021 of around 40 thousand deaths. Despite the absence of influenza in January-March 2021, a relevant excess was also observed among the working age population.

Objectives: We aimed at describing the attitudes towards influenza vaccination and a potential COVID-19 vaccine in Italy., Methods: A nationally representative survey based on 1055 Italians aged 15-85 years was conducted in September 16-28, 2020., Results: We found that 40.8% of the population reported the intention to be vaccinated against influenza next winter and 53.7% would accept to receive a potential COVID-19 vaccine. The percentages were higher among individuals aged 55 and over (58.8% for influenza vaccine and 58.2% for a potential COVID-19 vaccine) and among professionals, managers and teachers as compared to manual workers and farmers (36.1% vs. 27.6% for influenza vaccine and 51.6% vs. 44.8% for a potential COVID-19 vaccine)., Discussion: These data confirm a certain degree of vaccine mistrust in Italy, especially among less qualified workers.

Based on mortality data from 93% of Italian municipalities, there was an over 50% excess total mortality in March and a 38% excess in April, corresponding to over 46,000 excess deaths in those two months - as compared to 28,000 deaths attributed to COVID-19 in March and April. No subsequent excess mortality was observed, and in June reported total deaths were 6.2% less than expected. In the first 6 months of 2020, an 11.1% excess mortality was observed in Italy, and an almost 50% excess in Lombardy, the most affected region. Timely monitoring of total mortality has relevant implications for monitoring the COVID-19 pandemic and controlling occupational and social exposures.