Background: there is increasing concern that the COVID-19 pandemic has disproportionately affected the most vulnerable individuals.
Objectives: to determine whether education inequalities have widened during the first wave of the COVID-19 pandemic in Italy. DESIGN: historic cohort study based on administrative databases.
Setting and participants: the study was based on subjects registered in the Base Register of Individuals on 01.01.2019, aged >=35 years, and followed-up until 30.06.2020.
Main outcome measures: education inequalities in mortality before, during the first phase (March-April), and during the second phase (May-June) of the first pandemic wave in Italy were measured through the mortality rate ratios (MRRs). MMRs were estimated through negative binomial models. The interaction term between period and education was tested through the likelihood ratio test.
Results: the cohort included 37,976,670 individuals, and 719,665 of them died over the follow-up. In high pandemic areas, the MRR among less educated men were: 1.48 (95%CI 1.42-1.55) in the pre-pandemic period, 1.45 (95%CI 1.36-1.55) in the first phase and 1.42 (95%CI 1.30-1.56) in the second phase of the pandemic (p-value: 0.92). Corresponding figures among women were: 1.26 (95%CI 1.21-1.32), 1.39 (95%CI 1.30-1.49), and 1.35 (95%CI 1.23-1.48); p-value: 0.03. The MRRs substantially increased in the first pandemic phase among women aged 35-64 years (from 1.48 to 1.98; p-value; 0.011) and 65-79 years (from 1.22 to 1.51; p-value: 0.017). During the second phase, the MRRs returned to the values observed before the pandemic.
Conclusions: in Italy, education inequality in mortality widened during the COVID-19 pandemic among working-age women and those aged 65-79 years.
Keywords: COVID-19; Education; Mortality; Socioeconomic inequalities.