Abstract
PURPOSE: A sharp increase in diabetes-related mortality has been registered during the pandemic. Although immigrants are known to suffer from a higher prevalence of diabetes than host populations, data on diabetes-related mortality in pandemic years among immigrants are lacking. METHODS: All deaths with any mention of diabetes (multiple causes of death-MCOD) among subjects aged 20-64 years were extracted from the Italian National Cause of Death Register in the years 2019-2021. Directly age-standardized mortality rates (2013 European standard population) were computed. Standardized mortality ratios (SMR) for different immigrant groups were estimated with expected numbers based on rates registered among Italian citizens. RESULTS: Overall age-standardized mortality rates related to diabetes increased by 30% in 2020 compared to 2019, remaining high in 2021. Before the pandemic, large differences were observed across different immigrant groups; during the pandemic, the mortality disadvantage versus the native population widened among those already at increased risk. Among female immigrants, SMR in 2021 were 1.9 (95% Confidence Interval 1.1-2.8) in North Africans, 4.4 (2.5-6.3) in Sub-Saharan Africans and 2.8 (1.6-4.1) in South Asians. CONCLUSION: Surveillance based on MCOD is warranted to assess if the large differences in diabetes-related mortality observed across different populations living in Italy will reduce in the next years.