Italian study links social isolation to elderly COVID-19 cases

By Leah Sherwood, The Science Advisory Board assistant editor

May 27, 2020 -- A new study of COVID-19 infections in Italy suggests that factors associated with social isolation help explain why Italy's large senior population has been disproportionately affected by the COVID-19 pandemic. The findings were published May 21 in the journal PLOS One.

Italy has the world's second-oldest population, and people older than 80 have accounted for approximately 50% of the deaths in the country due to COVID-19. Around the world, there has been a clear association between the mortality rate from COVID-19 and age.

In the current study, a team led by Dr. Giuseppe Liotta, an associate professor of hygiene and public health from the University of Rome, was motivated by the question of whether intergenerational contact (closeness between younger and older generations in Italian families) was responsible for the greater severity of the COVID-19 pandemic among older Italian adults.

The data were based on the daily situation reports on COVID-19 published by the Italian Ministry of Health from February 28 through March 31, as well as publicly available household and population data published by each Italian administrative region.

For each region, the authors calculated the proportion of residents older than 80 among the total number of COVID-19 cases. They found considerable variation in the age of infected patients among regions, from the Basilicata region on the low end, where only 4.3% of infected patients were older than 80, to the Marche region, where 23.6% of infected patients were older than 80.

Ultimately, the researchers said that their findings failed to confirm a relationship between social connectedness in Italy and greater spread of COVID-19, as there was a negative correlation between mean household size and the percentage of residents older than 80 who were infected with the novel coronavirus. The Pearson correlation between household size and COVID-19 infection in the elderly was -0.602, indicating a negative correlation.

However, the authors did find a correlation between the proportion of COVID-19 infections in the elderly and two variables: percentage of households with one member and the nursing home beds rate.

Variables affecting proportion of COVID-19 infections in elderly in Italy
  Pearson correlation* p-value
Mean No. of household members -0.602 0.004
Percentage of households with 1 member 0.570 0.007
Nursing home beds rate 0.738 < 0.001
*Pearson correlation of 0 equals no correlation, 1 equals total correlation, and -1 equals total negative correlation.

Because both of these variables are associated with social isolation, the results suggest that social isolation is a greater risk factor for the elderly than intergenerational contact.

While the authors suggested that social distancing does not necessarily imply social isolation, they similarly offered that social connectedness does not imply physical closeness with social contacts.

In conclusion, they speculated that social relationships may, in fact, serve as a protective factor against increased mortality rates.

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