ROME (Reuters) – Poor Italians are significantly more likely to die of the coronavirus than higher-income groups, the country’s first significant study into the disease’s disproportionate social impact showed on Friday.

Italy is one of the world’s worst-hit countries with almost 35,000 COVID-19 deaths since its outbreak emerged on Feb. 21 and it was the first European nation to report large-scale infections.

In its annual report, national statistics bureau ISTAT studied mortality rates for each month from January 2019 to March 2020, when the outbreak took off, focusing on the education levels of those who died.

On average, Italians who leave school early with few qualifications have lower life-expectancy than those who study for longer, ISTAT said, and this “excess mortality” remained roughly constant through February this year.

In March however, the excess death ratio of the less educated in areas affected by the virus increased to 1.38 for men from 1.23 a year earlier, and jumped to 1.36 from 1.08 for women.

ISTAT statistician Linda Sabbadini said data on education levels was more readily available than other social indicators and was “an excellent proxy for income and class in Italy.”

“Disadvantaged socio-economic conditions expose people to greater risk of living in small or overcrowded housing, reducing the possibility of adopting social distancing measures,” the ISTAT report said.

Low-income groups were also more likely to be forced to work during lockdown, in sectors such as agriculture, public transport and assistance for the elderly, ISTAT said, concluding that COVID-19 had “accentuated pre-existing inequalities.”

In the 65-79 age group the excess mortality for men with few qualifications increased in March to 1.58 from 1.28 a year earlier. For women it jumped to 1.68 from 1.19.

The excess mortality for low-qualified working-age women (35-64) leapt in March to 1.76 from 1.37 in March 2019.

Among men and women over the age of 80, however, there was no disproportionate impact of the virus on the less educated, ISTAT found, while in areas of the country little-affected by the virus normal mortality rates continued in March this year.

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