# Diabetes-related mortality in the immigrant compared to the Italian population, before and during the pandemic

## TL;DR

During the pandemic, diabetes-related deaths increased more among immigrants in Italy compared to Italians, with some groups facing significantly higher risks.

## Contribution

This study quantifies the widening diabetes-related mortality gap between immigrant groups and Italians during the pandemic.

## Key findings

- Diabetes-related mortality increased by 30% in 2020 compared to 2019 and remained high in 2021.
- Sub-Saharan African female immigrants had the highest standardized mortality ratio (4.4) in 2021 compared to Italian women.
- Mortality disparities between immigrant groups and Italians widened during the pandemic.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s40618-025-02582-9.