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2.
Natl Vital Stat Rep ; 69(10): 1-12, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33054922

RESUMO

Objectives-This report describes the methodology used in the preparation of the 2009-2011 decennial life tables for the United States by race, Hispanic origin, and sex based on the age-specific death rates for the period 2009-2011, appearing in the report, "U.S. Decennial Life Tables for 2009-2011, United States Life Tables" (1). Methods-Data used to prepare these life tables include population data by age on the census date April 1, 2010; deaths occurring in the 3-year period 2009-2011 classified by age at death; births for each of the years 2007-2011; and Medicare data for ages 66-99 for the 3 years 2009-2011. The methods used differ from those applied to the 1999-2001 decennial life tables in the estimation of mortality for ages 66 and over. For the total, white, black, non-Hispanic white, and non-Hispanic black populations, the method developed for the U.S. annual life tables beginning with data year 2008 was used. It consists of the application of the Kannisto logistic model to smooth death rates in the age range 85-99 and predict death rates for ages 100-120 (2,3). For the Hispanic population, which is added to the decennial series for the first time with the 2009-2011 set, the method developed for the U.S. annual life tables beginning with data year 2006 was used. This method consists of using the Brass relational logit model to estimate mortality for ages 80-120 (4).


Assuntos
Tábuas de Vida , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Censos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicare , Estados Unidos/epidemiologia
3.
Natl Vital Stat Rep ; 69(8): 1-73, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33054929

RESUMO

Objectives-This report presents period life tables for the United States, based on age-specific death rates for the period 2009-2011. These tables are the most recent in a 110-year series of decennial life tables for the United States. Methods-This report presents complete life tables for the United States by race, Hispanic origin, and sex, based on age- specific death rates during 2009-2011. This is the first set of life tables by Hispanic origin presented in the U.S. decennial life table series. Data used to prepare these life tables include population estimates based on the 2010 decennial census; deaths occurring in the United States to U.S. residents in the 3 years 2009 through 2011; counts of U.S. resident births in the years 2007 through 2011; and population and death counts from the Medicare program for years 2009 through 2011. The methodology used to estimate life tables for the Hispanic population is based on the method first implemented with the 2006 annual U.S. life tables by Hispanic origin. The methodology used to estimate the life tables for all other groups is based on the method first implemented with the 2008 annual U.S. life tables. Results-During 2009-2011, life expectancy at birth was 78.60 years for the total U.S. population, representing an increase of 29.36 years from a life expectancy of 49.24 years in 1900. Between 1900 and 2010, life expectancy increased by 42.88 years for black females (from 35.04 to 77.92), by 39.21 years for black males (from 32.54 to 71.75), by 30.15 years for white females (from 51.08 to 81.23), and by 28.26 years for white males (from 48.23 to 76.49). During 2009-2011, Hispanic females had the highest life expectancy at birth (84.05), followed by non-Hispanic white females (81.06), Hispanic males (78.83), non-Hispanic black females (77.62), non-Hispanic white males (76.30), and non-Hispanic black males (71.41).


Assuntos
Expectativa de Vida/etnologia , Tábuas de Vida , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Censos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicare , Estados Unidos/epidemiologia
4.
Huan Jing Ke Xue ; 41(10): 4482-4494, 2020 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-33124380

RESUMO

In this research, the activity data of Sichuan Province were collected using bottom-up and top-down methods. According to the second survey of pollution sources, the activity data of industrial source includes information of 11020 boilers and 60078 industrial enterprises. Data of 19152 industrial enterprises were collected in Chengdu, accounting for 32% of the total number of enterprises in Sichuan Province. The anthropogenic air pollutant emission inventory of 9 km×9 km was developed for Sichuan Province in 2017 with the use of appropriate emission estimation methods. The results showed that the total emission of SO2,NOx,CO,PM10,PM2.5,BC,OC,VOCs, and NH3 in Sichuan were 308.6×103, 725.7×103, 3131.2×103, 927.6×103, 422.4×103, 30.2×103, 72.0×103, 600.9×103, and 887.1×103 t. The fixed combustion source and process source mainly contributed as sources of SO2. The main source of CO was the process source and mobile source. Further, the dust source and process source were the main sources of PM10 and PM2.5, and the dust source was the largest source of BC and OC contributions. The emission sources of the VOCs were primarily the process sources, mobile sources and solvent use sources. The NH3 emissions were mainly from livestock and poultry breeding and nitrogen fertilizer applications. The spatial distribution results showed that the pollutants were mainly concentrated in the densely populated Sichuan basin and Panzhihua region, where industry and agriculture were relatively developed. The high value points are concentrated along the Deyang-Chengdu-Meishan-Leshan line in Chengdu Plain. The emission inventory established in this study still has certain uncertainties, and the accuracy of activity level data acquisition should be further enhanced. Moreover, pollutant emission factor testing should be carried out for typical pollution sources, and grid emission inventory should be improved to provide scientific support for the prevention and control of air pollution in Sichuan Province in the future.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Animais , Censos , Monitoramento Ambiental , Poluição Ambiental
6.
J Registry Manag ; 47(1): 4-12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833378

RESUMO

OBJECTIVES: Researchers often approximate individual-level socioeconomic status (SES) from census tract and county data. However, area-level variables do not serve as accurate proxies for individual-level SES, particularly among some demographic subgroups. The present study aimed to analyze the potential bias introduced by this practice. METHODS: Data included (1) individual-level SES from the Mortality Disparities in American Communities study (n ≈ 3,471,000 collected in 2008), and (2) census tract- and county-level SES from the 2006-2010 American Community Survey. Analyses included correlations among SES indicators (eg, median household income, having a high school degree, unemployment) across individual versus census tract and county levels, stratified by sex, age, race/ethnicity, and urbanicity. Finally, generalized estimating equations evaluated demographic differences in whether area-level SES matched or underestimated individual-level SES. RESULTS: Low correlations were observed between individual- and area-level SES (census tract: Spearman's r range = 0.048 for unemployment to 0.232 for median household income; county: r range = 0.028 for unemployment to 0.157 for median household income; all P < .0001). SES indicators were more likely to match for males, older participants, and urban groups. Area-level SES indicators were more likely to underestimate individual-level SES for older participants and rural groups, indicating that individuals who are part of these groups may live in systematically lower-SES communities than their own SES might connote. CONCLUSIONS: In this population-based study of 3.5 million participants, area-level indicators were poor proxies for individual-level SES, particularly for participants living in rural areas.


Assuntos
Censos , Sistema de Registros/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Feminino , Humanos , Masculino , População Rural/estatística & dados numéricos , Classe Social , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
7.
Artigo em Inglês | MEDLINE | ID: mdl-32785046

RESUMO

The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Betacoronavirus , Censos , Mapeamento Geográfico , Humanos , Ohio/epidemiologia , Pandemias , Análise de Componente Principal , Fatores Socioeconômicos
8.
PLoS One ; 15(8): e0237063, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756580

RESUMO

Country-level census data are typically collected once every 10 years. However, conflicts, migration, urbanization, and natural disasters can rapidly shift local population patterns. This study demonstrates the feasibility of a "bottom-up"-method to estimate local population density in the between-census years by combining household surveys with contemporaneous geo-spatial data, including village-area and satellite imagery-based indicators. We apply this technique to the case of Sri Lanka using Poisson regression models based on variables selected using the Least Absolute Shrinkage and Selection Operator (LASSO). The model is estimated in villages sampled in the 2012/13 Household Income and Expenditure Survey, and is employed to obtain out-of-sample density estimates in the non-surveyed villages. These estimates approximate the census density accurately and are more precise than other bottom-up studies using similar geo-spatial data. While most open-source population products redistribute census population "top-down" from higher to lower spatial units using areal interpolation and dasymetric mapping techniques, these products become less accurate as the census itself ages. Our method circumvents the problem of the aging census by relying instead on more up-to-date household surveys. The collective evidence suggests that our method is cost effective in tracking local population density with greater frequency in the between-census years.


Assuntos
Mapeamento Geográfico , Densidade Demográfica , Censos , Humanos , Imagens de Satélites/métodos , Sri Lanka/etnologia , Inquéritos e Questionários
9.
Public Health ; 186: 44-51, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32768623

RESUMO

BACKGROUND: Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS: The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS: Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION: Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.


Assuntos
Comportamento Autodestrutivo/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Censos , Criança , Bases de Dados Factuais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32726942

RESUMO

In the US, the incidence of depression and suicide have followed escalating trends over the past several years. These trends call for greater efforts towards identifying their underlying drivers and finding effective prevention strategies and treatments. One social determinant of health that plausibly influences the risk of depression is income inequality, the gap between the rich and poor. However, research on this association is still sparse. We used data from the National Longitudinal Survey of Youth 1979 and the US Census to investigate the multilevel lagged associations of state-level income inequality with the individual-level odds of depression in middle-aged adults, controlling for state- and individual-level factors. We also examined the independent associations of county-level social capital with depression and explored whether it mediated the income inequality relationship. Higher income inequality at the state level predicted higher odds of individual-level depression nearly 2 decades later [OR for middle vs. lowest tertile of income inequality = 1.35 (95% CI: 1.02, 1.76), OR for highest vs. lowest tertile = 1.34 (95% CI: 1.01, 1.78)]. This association was stronger among men than women. Furthermore, there was evidence that county-level social capital independently predicted depression and that it mediated the income inequality association. Overall, our findings suggest that policies attenuating levels of income inequality at the US state level and that leverage social capital may protect against one's likelihood of developing depression.


Assuntos
Depressão , Renda , Capital Social , Idoso , Censos , Depressão/economia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-32610538

RESUMO

Many studies have analysed socioeconomic inequalities and its association with mortality in urban areas. However, few of them have differentiated between native and immigrant populations. This study is an ecological study of mortality by overall mortality and analyses the inequalities in mortality in these populations according to the level of deprivation in small areas of large cities in the Valencian Community, from 2009 to 2015. The census tract was classified into five deprivation levels using an index based on socioeconomic indicators from the 2011 census. Rates and relative risks of death were calculated by sex, age, level of deprivation and country of birth. Poisson regression models have been used. In general, there was a higher risk of death in natives at the levels of greatest deprivation, which did not happen in immigrants. During the 2009-2015 period, there were socioeconomic inequalities in mortality, particularly in natives, who presented a higher risk of death than immigrants. Future interventions and social policies should be implemented in order to reduce inequalities in mortality amongst socioeconomic levels and to maintain the advantage that the immigrant population enjoys.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade/tendências , Censos , Cidades , Feminino , Humanos , Mortalidade/etnologia , Parto , Gravidez , Fatores Socioeconômicos , Espanha/epidemiologia
12.
PLoS One ; 15(7): e0235282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667928

RESUMO

The firm size distribution is highly skewed to the right and often follows a power law. In practice, it is common that firm size and firm age data are aggregated and released as grouped data to avoid disclosure of confidential information. We investigate multiple parametric methods for firm size and firm age modeling based on grouped data, and propose to estimate the joint distribution of firm size and firm age using the Plackett copula. The goodness-of-fit of the estimated marginal distributions are benchmarked with respect to the fit to the whole data and to the upper tails, respectively. The utilization of the proposed methods are demonstrated via an application to the 1977-2014 US firm data. Results show that the generalized lambda distribution has overall better performance in modeling both firm size and firm age data. The exponentiated Weibull distribution also works well in modeling the firm size data. As a by-product, the estimated parameter of the Plackett copula provides a measure of the association between firm size and firm age.


Assuntos
Comércio/estatística & dados numéricos , Modelos Estatísticos , Distribuições Estatísticas , Recursos Humanos/estatística & dados numéricos , Algoritmos , Censos , Simulação por Computador , Emprego/estatística & dados numéricos , Humanos , Fatores de Tempo , Estados Unidos
13.
PLoS One ; 15(6): e0235224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603345

RESUMO

High quality census data are not always available in developing countries. Instead, mobile phone data are becoming a popular proxy to evaluate the density, activity and social characteristics of a population. They offer additional advantages: they are updated in real-time, include mobility information and record visitors' activity. However, we show with the example of Senegal that the direct correlation between the average phone activity and both the population density and the nighttime lights intensity may be insufficiently high to provide an accurate representation of the situation. There are reasons to expect this, such as the heterogeneity of the market share or the particular granularity of the distribution of cell towers. In contrast, we present a method based on the daily, weekly and yearly phone activity curves and on the network characteristics of the mobile phone data, that allows to estimate more accurately such information without compromising people's privacy. This information can be vital for development and infrastructure planning. In particular, this method could help to reduce significantly the logistic costs of data collection in the particularly budget-constrained context of developing countries.


Assuntos
Telefone Celular , Censos , Densidade Demográfica , Coleta de Dados/métodos , Países em Desenvolvimento , Eletricidade , Humanos , Senegal
14.
Science ; 369(6501): 253-254, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32675362
15.
Proc Natl Acad Sci U S A ; 117(30): 17688-17694, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32661145

RESUMO

Studies on geographic inequalities in life expectancy in the United States have exclusively focused on single-level analyses of aggregated data at state or county level. This study develops a multilevel perspective to understanding variation in life expectancy by simultaneously modeling the geographic variation at the levels of census tracts (CTs), counties, and states. We analyzed data from 65,662 CTs, nested within 3,020 counties and 48 states (plus District of Columbia). The dependent variable was age-specific life expectancy observed in each of the CTs. We also considered the following CT-level socioeconomic and demographic characteristics as independent variables: population density; proportions of population who are black, who are single parents, who are below the federal poverty line, and who are aged 25 or older who have a bachelor's degree or higher; and median household income. Of the total geographic variation in life expectancy at birth, 70.4% of the variation was attributed to CTs, followed by 19.0% for states and 10.7% for counties. The relative importance of CTs was greater for life expectancy at older ages (70.4 to 96.8%). The CT-level independent variables explained 5 to 76.6% of between-state variation, 11.1 to 58.6% of between-county variation, and 0.7 to 44.9% of between-CT variation in life expectancy across different age groups. Our findings indicate that population inequalities in longevity in the United States are primarily a local phenomenon. There is a need for greater precision and targeting of local geographies in public policy discourse aimed at reducing health inequalities in the United States.


Assuntos
Variação Biológica da População , Censos , Expectativa de Vida , Feminino , Geografia , Humanos , Masculino , Estados Unidos/epidemiologia
16.
Epidemiol Psychiatr Sci ; 29: e140, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32635966

RESUMO

AIMS: Mental ill-health is a known risk factor for suicide mortality. However, the relationship between physical ill-health and suicide is less clear. This study examined the relationship between different aspects of physical ill-health and the risk of suicide death. METHODS: Data for 1 196 364 adults (aged 18 years and over) were identified from the 2011 Northern Ireland Census and linked to death registrations until the end of 2015. Multivariate logistic regression was used to construct models to test associations with likelihood ratio tests for interactions. RESULTS: Over one in eight individuals (13.7%) reported multimorbidity (⩾2 physical health conditions) and one in four (25.4%) identified having limitation of daily activities. During follow-up, 51 672 individuals died; 877 due to suicide. The gradient in suicide risk by number of physical conditions disappeared following adjustment for activity limitation. Individuals with a lot of activity limitation were over three times more likely to die by suicide (OR = 3.13, 95% CI 2.50-3.93) compared to those with no limitations though this was reduced to OR = 1.72 (95% CI 1.35-2.20) with adjustment for poor mental health. The relationship between activity limitation and suicide was most pronounced at younger ages (18-34 years). CONCLUSIONS: This study suggests that it is the effect that physical illness has on a person's life, in terms of disruption to daily activity, rather than the number of conditions that predicts suicide risk, especially at younger ages. Improved awareness and better management of mental wellbeing of individuals with physical health conditions may help to reduce suicides, especially in younger people.


Assuntos
Doença Crônica/psicologia , Qualidade de Vida , Tentativa de Suicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Censos , Doença Crônica/epidemiologia , Feminino , Seguimentos , Nível de Saúde , Humanos , Irlanda/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Mortalidade , Multimorbidade , Fatores de Risco , Suicídio/psicologia , Tentativa de Suicídio/psicologia , Adulto Jovem
17.
BMC Public Health ; 20(1): 871, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503495

RESUMO

BACKGROUND: Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Sub-Saharan Africa carries the highest burden of epilepsy. The management of epilepsy in Cameroon remains unsatisfactory due to poor identification of cases and a limited knowledge of the distribution of the disease. The objective of this study was to determine whether community drug distributors (CDDs) - volunteers selected by their communities to distribute ivermectin against onchocerciasis and who have been proven efficient to deliver other health interventions such as insecticide-treated bed nets to prevent malaria, vitamin A tablets, and albendazole to treat soil transmitted helminthiasis - can be used to reliably identify people living with epilepsy to promote better management of cases. METHODS: This study was carried out in three health Districts in Cameroon. An exhaustive house to house census was carried out by trained CDDs under the supervision of local nurses. In each household, all suspected cases of epilepsy were identified. In each health district, five communities were randomly selected for a second census by trained health personnel (research team). The results of the two censuses were compared for verification purposes. RESULTS: A total of 53,005 people was registered in the 190 communities surveyed with 794 (1.4%) individuals identified as suspected cases of epilepsy (SCE) by the CDDs. In the 15 communities where the SCE census was verified, the average ratio between the number of suspected cases of epilepsy reported in a community by the research team and that reported by the CDDs was 1.1; this ratio was < 0.8 and > 1.2 in 6 communities. CONCLUSIONS: The results of this study suggest that CDDs, who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and therefore map epilepsy in many African countries.


Assuntos
Censos , Serviços de Saúde Comunitária/métodos , Epilepsia/epidemiologia , Inquéritos Epidemiológicos/métodos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Camarões/epidemiologia , Características da Família , Feminino , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Voluntários , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-32503250

RESUMO

Afforestation programs have become increasingly significant as policymakers attempt to protect the environment and reduce climate change. Although many studies have examined the participation decisions of forest farm households in afforestation programs, these studies fail to consider different types of these policies. This paper fills this knowledge gap by studying the determinants of forest farms participating in two afforestation programs on plain and sloped land in Taiwan. We construct a population-based sample of forest farms drawn from agricultural census surveys in Taiwan and estimate the multinomial logit model. We find that failing to distinguish between afforestation programs may result in misleading findings. Moreover, socio-demographic and farm production characteristics also affect participation decisions. Additional results from a simple simulation exercise show that forest farms are more likely to enroll in afforestation programs on sloped land, possibly due to lower opportunity costs.


Assuntos
Censos , Fazendeiros , Adulto , Agricultura , Feminino , Florestas , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Taiwan
20.
Acta Biomed ; 91(2): 45-49, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: covidwho-295630

RESUMO

BACKGROUND: The spread of coronavirus disease 2019 (COVID-19) is overwhelming the response of many regional health services across Italy. This article aims to report and discuss the data of the first 8 weeks of COVID-19 epidemic in the emergency department (ED) of the University Hospital of Parma. METHODS: The ED visits were analyzed as follows: total ED visits, divided in COVID-19/ non-COVID-19 cases, and in trauma-related/non-trauma-related cases; outcome (i.e., discharged, admitted, dead in the ED) of patients, altogether or stratified according to triage class; age classes of the entire ED population. RESULTS: Total ED visits decreased starting from the first days of the outbreak, then exhibiting progressive growth afterwards. COVID suspected cases rapidly increased, whereas non-COVID suspected dropped and remained well below the standard. Trauma-related cases declined, both as ED visits and as hospital admissions. The percentage and absolute number of patients admitted to hospital wards progressively increased, rapidly overwhelming the number of cases that could be discharged. The admission rate in the lowest priority classes also displayed a marked increase. The youngest age classes dramatically declined, whilst the oldest progressively increased, remaining considerably over the standard rate of the local ED. CONCLUSIONS: The COVID-19 pandemic has obliged the health care systems to undergo a paradigm shift. Even triage criteria have partially lost their meaning, as shown by the dramatic increase of hospital admissions, even in the lowest priority classes. A deep re-organizational process of the ED was undertaken. Hospitals must be constantly resilient and prepared to these new emergencies in terms of equipment, medical and nurses staff, larger bed capacity in short time, availability of intensive and sub-intensive beds, and flexibility.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Censos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Epidemias , Hospitais Urbanos , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
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