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This paper explores the relationship between the spatial distribution of excess deaths and the presence of care home facilities during the first wave of the COVID-19 outbreak in Italy. Using registry-based mortality data for Lombardy, one of the areas most severely hit by the pandemic we show that the presence of a care home in a municipality is associated with significantly higher excess death rates in the population. This effect appears to be driven by excess mortality in the elderly population of 70 years old and older. Our results are robust to controlling for the number of residents in each care home, suggesting that the presence of such facilities may have acted as one of factors contributing to the diffusion of COVID-19 at the local level.

Original publication




Journal article


Health econ

Publication Date





1703 - 1710


COVID-19, care homes, excess mortality, Aged, Aged, 80 and over, COVID-19, Cause of Death, Coronavirus Infections, Female, Humans, Italy, Male, Nursing Homes, Registries