One of the victims was a 106-year-old woman who was killed in her bed when a roof beam fell on her.
The 6.0 magnitude temblor inflicted serious damage to many historic churches and other buildings, including a famed medieval castle that was the symbol of the town of San Felice Sul Panaro.
The ministry of cultural heritage in Rome said damage to historic buildings and the artistic treasures they contained was “significant.”
Officials estimate more than 3,000 people would be unable to immediately return to their homes due to structural damage.
Shaking was felt widely across northern Italy from the French border to the west to Slovenia to the East.
The U.S. Geological Survey said the quake struck at 4:04 a.m. local time about 22 miles west-northwest of Bologna at a depth of just under 7 miles.
Strong aftershocks kept terrified residents outside across the region, and caused some structures damaged by the initial jolt to collapse.
Large stocks of Emilia Romagna’s renowned balsamic vinegar and prosciutto ham were said to be lost in collapsed buildings.
The Telegraph reports more than 300,000 wheels of Grana Padano and Parmigiano Reggiano cheese, worth millions of dollars, were also destroyed in warehouses and stockrooms affected by the quake.
Sunday's temblor was the worst to strike Italy since the L'Aquila earthquake killed nearly 300 people in the heart of the country in 2009.