Mapping the COVID-19 epidemic in Lombardy, Italy, years 2020–2022: a population-based study of temporal trends, geographic distribution, and risk factors for incidence, hospitalization, and mortality

@article{villa2026mapping,
  title = {{Mapping the COVID-19 epidemic in Lombardy, Italy, years 2020–2022: a population-based study of temporal trends, geographic distribution, and risk factors for incidence, hospitalization, and mortality}},
  author = {Simone Villa and Pietro Magnoni and Cristina Mazzali and Alberto Zucchi and Giovanni Maifredi and Luca Cavalieri d’Oro and Maria Letizia Gambino and Anna Clara Fanetti and Pietro Giovanni Perotti and Marco Villa and Maria Grazia Valsecchi and Daria Vigani and Claudio Lucifora and Fabrizio Ernesto Pregliasco and Danilo Cereda and Olivia Leoni and Antonio Giampiero Russo and the PASCNET study group and Federico Franzoni and Gabriele Letta and Laura Antolini and Giuseppe Lapadula and Elena Tassistro and Stefano Denicolai and Marica Grego and Diala Kabbara and Costanza Baldrighi and Alberto Milanese and Rossella Murtas and Andrea Salvatori and Deborah Testa and Sara Tunesi and Adele Zanfino and Simona Dalle Carbonare and Federica Manzoni and Simona Migliazza and Linda Guarda and Silvia Tillati and Giacomo Crotti and Giuseppe Sampietro and Anita Andreano and Elisabetta Merlo and Magda Rognoni and Piersimone Fontana and Ivan Cometti and Monica Lanzoni and Giuseppe Emanuele La Piana and Anna Bussi and Vincenzo Belcastro and Stefano Rusconi and Luigi Magnani and Maurizio Morlotti and Andrea Patroni and Raffaele Bruno and Elisabetta Pagani and Paolo Sacchi and Valentina Zuccaro},
  journal = {BMC Public Health},
  year = {2026},
  month = oct,
  doi = {10.1186/s12889-026-29682-2},
  url = {https://link.springer.com/10.1186/s12889-026-29682-2},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Mapping the COVID-19 epidemic in Lombardy, Italy, years 2020–2022: a population-based study of temporal trends, geographic distribution, and risk factors for incidence, hospitalization, and mortality
AU  - Simone Villa
AU  - Pietro Magnoni
AU  - Cristina Mazzali
AU  - Alberto Zucchi
AU  - Giovanni Maifredi
AU  - Luca Cavalieri d’Oro
AU  - Maria Letizia Gambino
AU  - Anna Clara Fanetti
AU  - Pietro Giovanni Perotti
AU  - Marco Villa
AU  - Maria Grazia Valsecchi
AU  - Daria Vigani
AU  - Claudio Lucifora
AU  - Fabrizio Ernesto Pregliasco
AU  - Danilo Cereda
AU  - Olivia Leoni
AU  - Antonio Giampiero Russo
AU  - the PASCNET study group
AU  - Federico Franzoni
AU  - Gabriele Letta
AU  - Laura Antolini
AU  - Giuseppe Lapadula
AU  - Elena Tassistro
AU  - Stefano Denicolai
AU  - Marica Grego
AU  - Diala Kabbara
AU  - Costanza Baldrighi
AU  - Alberto Milanese
AU  - Rossella Murtas
AU  - Andrea Salvatori
AU  - Deborah Testa
AU  - Sara Tunesi
AU  - Adele Zanfino
AU  - Simona Dalle Carbonare
AU  - Federica Manzoni
AU  - Simona Migliazza
AU  - Linda Guarda
AU  - Silvia Tillati
AU  - Giacomo Crotti
AU  - Giuseppe Sampietro
AU  - Anita Andreano
AU  - Elisabetta Merlo
AU  - Magda Rognoni
AU  - Piersimone Fontana
AU  - Ivan Cometti
AU  - Monica Lanzoni
AU  - Giuseppe Emanuele La Piana
AU  - Anna Bussi
AU  - Vincenzo Belcastro
AU  - Stefano Rusconi
AU  - Luigi Magnani
AU  - Maurizio Morlotti
AU  - Andrea Patroni
AU  - Raffaele Bruno
AU  - Elisabetta Pagani
AU  - Paolo Sacchi
AU  - Valentina Zuccaro
PY  - 2026
DA  - 2026/10/02
JO  - BMC Public Health
DO  - 10.1186/s12889-026-29682-2
UR  - https://link.springer.com/10.1186/s12889-026-29682-2
AB  - Background: In late winter of 2020, the first locally transmitted outbreak of COVID-19 in Europe was reported in Lombardy, Italy. This study provides a comprehensive analysis of the epidemic’s trajectory in this heavily impacted region from March 2020 to the end of 2022.  Methods: We conducted a cohort study utilizing anonymized data from Lombardy’s eight local public health authorities (LPHAs). The dataset included all individuals registered with the Regional Health Service as of January 2020, with monthly data aggregated by sex, age, country of origin, municipality or ZIP area, and comorbidities. SARS-CoV-2 lineage data from the regional repository allowed us to segment the study period into four sub-periods by predominant viral lineages. We report the temporal trends and geographical distribution of three outcomes (COVID-19 incidence, hospital admissions, and mortality) as well as COVID-19 test positivity rates and vaccination coverage across LPHAs and Local Health Districts (LHDs). Multivariable regression models were employed to identify key risk factors for COVID-19 incidence and mortality in each of the four sub-periods.  Results: We describe the impact of the COVID-19 pandemic in a population of over 10 million people, of whom 45% were aged ≥ 50 years and 22% had a history of cardiac diseases. The outbreak was concentrated, in the early phases, in a few LHDs, none of which had large cities. As soon as the SARS-CoV-2 transmission increased in the population, hospital admissions and mortality decreased over time, especially for areas impacted early. Our results confirm the role of age and neurologic and renal comorbidities, as well as geographical location, hinting at the impact of local epidemic dynamics and health system factors on both outcomes.  Conclusions: Our findings provide essential insights into the dynamics of COVID-19 in one of Europe’s earliest and most severely affected regions, contributing valuable evidence to the global understanding of pandemic management and public health responses.
SN  - 1471-2458
ER  -