Nomenclature of Territorial Units for Statistics - Example Problems Nomenclature of Territorial Units for Statistics From Example Problems Jump to: navigation , search The Nomenclature of Territorial Units for Statistics (NUTS) is a geocode standard for referencing the administrative division of countries for statistical purposes. The standard was developed by the European Union , and thus only covers the member states of the EU in detail; Eurostat also devised a hierarchy for the 10 countries which joined the EU in 2004 , but these are subject to minor changes. The NUTS divisions do not necessarily correspond to administrative divisions within the country. The acronym is derived from the French name for the scheme, nomenclature des unités territoriales statistiques. A NUTS code begins with a two letter code referencing the country, which are identical with the ISO 3166-1 codes (except UK instead of GB for the United Kingdom ). The subdivision of countries is then referred with one number, covering the same entities as the ISO 3166-2 standard. A second or third subdivision level is referred with another number each. Each numbering starts with 1 as 0 is used for the upper level.

In case it has more than 9 entities capital letters are used to continue the numbering. Additionally to the full three levels for the European Union countries all countries have a NUTS code with a two letter code for a continent and two numbers for the country, and for the USA, Canada and Australia the states are numbered separately. There are some anomalies: for example, Gibraltar is listed as being outside the EU with the code EO21; while French Guiana is listed twice, once in France as FR930 and once in South America as AS13. NUTS is thus in some extent similar to the ISO 3166 standard, as well as the FIPS standard of the United States. Levels There are three levels of NUTS defined, with two levels of local administrative units (LAUs) below that, historically called NUTS levels 4 and 5 and sometimes still described as such. Note that not all countries have every level of division. Luxembourg, for example, has only LAUs; the three NUTS divisions each correspond to the entire country itself.

Countries Learn and talk about First-level NUTS of the European Union, NUTS 1 statistical regions of the European Union, Nomenclature of Territorial Units for Statistics ( Learn how and when to remove this template message ) The Nomenclature of Territorial Units for Statistics , (NUTS, for the French nomenclature d'unités territoriales statistiques), is a geocode standard for referencing the administrative divisions of countries for statistical purposes. The standard was developed by the European Union . There are three levels of NUTS defined, with two levels of local administrative units (LAUs) below. Not all countries have every level of division, depending on their size. One of the most extreme cases is Luxembourg, which has only LAUs; the three NUTS divisions each correspond to the entire country itself. Below are the first level NUTS regions of the European Union. Contents Original courtesy of Wikipedia: — Please support Wikipedia. This page uses Creative Commons Licensed content from Wikipedia . A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia. We're sorry, but there's no news about "First-level NUTS of the European Union" right now.

Limit to books that you can completely read online Include partial books (book previews) Oops, we seem to be having trouble contacting Twitter Support Wikipedia A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia. Please add your support for Wikipedia! Searchlight Group Digplanet also receives support from Searchlight Group. Visit Searchlight Copyright © 2009-2016 Digparty. All rights reserved. Nomenclature of Territorial Units for Statistics | The Countries Wiki | Fandom powered by Wikia Nomenclature of Territorial Units for Statistics 1,277pages on The Nomenclature of Territorial Units for Statistics (NUTS) is a geocode standard for referencing the administrative divisions of countries for statistical purposes. The standard was developed by the European Union . NUTS1 The first level NUTS of the European Union.

Country Drought indicator time series for European NUTS regions based on remote sensing data (2000-2015) - Datasets - European Data Portal Activity Stream Drought indicator time series for European NUTS regions based on remote sensing data (2000-2015) This dataset consists in a collection of remotely sensed drought indicators time series. The data was extracted from CEH’s gridded remotely sensed drought indicators product (Tanguy et al., 2016 ), which has gridded data for Europe for three drought indicators: - the Vegetation Condition Index (VCI) based on satellite product NDVI (Normalised Difference Vegetation Index); - the Temperature Condition Index (TCI) based on remotely sensed LST (Land Surface Temperature); - the Vegetation Health Index (VHI) which is a combination of VCI and TCI. These three drought indicators have been extracted for European NUTS regions (level 0, 1, 2 and 3). These have been masked with a land use land cover map to be able to study different responses for various land cover types.

A simplified LULC was created, with only four classes: forest, crop, shrub and grass. One extra time series was created for all classes together. The data is stored in CSV file format. Distributions December 18, 2016, 10:01 (UTC) Created December 18, 2016, 10:01 (UTC) Issued 2016-07-11 Provenance Label: Time series for three drought indicators based on remote sensing have been extracted for European NUTS regions (level 0, 1, 2 and 3). The Nomenclature of Territorial Units for Statistics, (NUTS, for the French nomenclature d'unités territoriales statistiques), developed by the European Union, is a geocode standard for referencing the administrative divisions of countries for statistical purposes. A land use mask was applied to extract the time series, to differentiate the contribution of crops, grass, forest and shrubs. There is also one time series for each NUTS region which includes all classes.

The land cover product used to produce the mask was remote sensing MODIS product MCD12C1 (year 2012) which has a 0.05 degree resolution. The three drought indicators extracted are (i) the Vegetation Condition Index (VCI) based on satellite product NDVI (Normalised Difference Vegetation Index) (ii) the Temperature Condition Index based on remotely sensed LST (Land Surface Temperature) and (iii) the Vegetation Health Index (VHI) which is a combination of VCI and TCI. These indicators were first calculated as a gridded product for Europe with a 0.05 degree resolution and monthly time step (2000-2015), using MODIS product MOD13C2 for NDVI, and MODIS product MOD11C3 for LST, following methodology described by Kogan (1995). The time series were then extracted applying the simplified land use classification mask (crops, forest, grass, shrubs) to each NUTS region, and an additional time series for all classes.

For each time step, a value was produced only if at least 50% of the pixels within the non-masked area had valid values. NOTE: there are two types of "No Data" value. Value '--' means there were no pixels with valid values within the non-masked area. Value 'nan' means there were some pixels with valid values within the non-masked area, but these covered less than 50% of the area. These time steps were discarded as less than 50% was considered not representative enough of the whole area. Reference: Kogan, F.N., 1995. Application of vegetation index and brightness temperature for drought detection. Adv. Sp. Res. 15, 91–100.

doi:10.1016/0273-1177(95)00079-T Contact Point About: Nomenclature of Territorial Units for Statistics About: Nomenclature of Territorial Units for Statistics An Entity of Type : Event100029378 , from Named Graph : , within Data Space : dbpedia.org The Nomenclature of Territorial Units for Statistics or Nomenclature of Units for Territorial Statistics (NUTS for French Nomenclature des unités territoriales statistiques) is a geocode standard for referencing the subdivisions of countries for statistical purposes. The standard is developed and regulated by the European Union, and thus only covers the member states of the EU in detail. The Nomenclature of Territorial Units for Statistics is instrumental in the European Union's Structural Fund delivery mechanisms. Property abstract NUTS (französisch Nomenclature des unités territoriales statistiques) bezeichnet eine hierarchische Systematik zur eindeutigen Identifizierung und Klassifizierung der räumlichen Bezugseinheiten der amtlichen Statistik in den Mitgliedstaaten der Europäischen Union.

Sie lehnt sich eng an die Verwaltungsgliederung der einzelnen Länder an. In der Regel entspricht eine NUTS-Ebene einer Verwaltungsebene oder einer räumlichen Aggregation von Verwaltungseinheiten. Eine vergleichbare Systematik gibt es auch in den EFTA- und CEC-Ländern. Diese Systematik wurde 1980 vom Europäischen Amt für Statistik in Luxemburg entwickelt, um regionale Raumeinheiten innerhalb Europas auch international statistisch vergleichen zu können. NUTS-Regionen sind die Grundlage für die quantitative Beurteilung von Regionen durch die EU. Im Rahmen der Regionalpolitik werden Fördermittel konkreten NUTS-Regionen (v. a. NUTS-3-Regionen) zugewiesen. (de) NUTS, la Nomenclatura de las Unidades Territoriales Estadísticas (derivado de las siglas en francés de Nomenclature des Unités Territoriales Statistiques), son una serie de demarcaciones territoriales utilizadas por la Unión Europea con fines estadísticos.

Fueron creadas por la Oficina Europea de Estadística (Eurostat) para dar uniformidad en las estadísticas regionales europeas y son utilizadas, entre otras cosas, para la redistribución regional de los fondos estructurales de la UE. En 1988 fueron aprobadas en la Legislación Comunitaria, pero no fue hasta el 2003 cuando entraron plenamente en función en el reglamento del Parlamento Europeo La nomenclatura NUTS tiene una estructura jerárquica de tres niveles, de las cuales las regiones NUTS-1 representan la jerarquía mayor, más dos niveles de unidades administrativas locales (en inglés LAU) que también se llaman NUTS niveles 4 y 5. (es) La nomenclature des unités territoriales statistiques est un découpage territorial destiné à faciliter les comparaisons entre pays, ou entre régions, d'un même ensemble.

(fr) The Nomenclature of Territorial Units for Statistics or Nomenclature of Units for Territorial Statistics (NUTS for French Nomenclature des unités territoriales statistiques) is a geocode standard for referencing the subdivisions of countries for statistical purposes. The standard is developed and regulated by the European Union, and thus only covers the member states of the EU in detail. The Nomenclature of Territorial Units for Statistics is instrumental in the European Union's Structural Fund delivery mechanisms. For each EU member country, a hierarchy of three NUTS levels is established by Eurostat; the subdivisions in some levels do not necessarily correspond to administrative divisions within the country. A NUTS code begins with a two-letter code referencing the country, which is identical to the ISO 3166-1 alpha-2 code (except UK instead of GB for the United Kingdom and EL instead of GR for Greece). The subdivision of the country is then referred to with one number. A second or third subdivision level is referred to with another number each. Each numbering starts with 1, as 0 is used for the upper level. Where the subdivision has more than nine entities, capital letters are used to continue the numbering.

A similar statistical system is defined for the candidate countries and members of the European Free Trade Association, but they are not technically part of NUTS governed by the regulations. The current NUTS classification, valid from 1 January 2012 until 31 December 2014, lists 97 regions at NUTS 1, 270 regions at NUTS 2 and 1294 regions at NUTS 3 level. In addition to the full three levels for the European Union countries, all other countries have a NUTS code with a two-letter code for a continent and two numbers for the country, and for the USA, Canada and Australia the states, provinces, and territories are numbered separately. There are some anomalies: for example, Gibraltar is listed as being outside the EU with the code EO21; while French Guiana is listed twice, once in France as FR930 and once in South America as AS13. NUTS is thus in some extent similar to the ISO 3166-2 standard, as well as the FIPS 10-4 standard of the United States.

(en) تسمية الوحدات الإقليمية للإحصاء أو Nomenclature of Units for Territorial Statistics (NUTS وهو اختصار ل‏(بالفرنسية Nomenclature des unités territoriales statistiques) هو معيار ترميز جغرافي للإشارة للتقسيمات الإدارية للدول لأغراض إحصائية. وقد تم تنظيم وتطوير المعايير بواسطة الاتحاد الأوروبي، وبالتالي فهي تغطي فقط الدول الأعضاء في الاتحاد الأوروبي بالتفصيل. تسمية الوحدات الإقليمية للإحصاء يستفاد منها في آيات الصندوق الهيكلي بالاتحاد الأوروبي. (ar) La nomenclatura delle unità territoriali statistiche, in acronimo NUTS (dal francese Nomenclature des unités territoriales statistiques) identifica la ripartizione del territorio dell'Unione europea a fini statistici. È stata ideata dall'Eurostat nel 1988 tenendo come riferimento di base l'unità amministrativa locale.

Da allora è la principale regola per la redistribuzione territoriale dei fondi strutturali della UE, fornendo uno schema unico di ripartizione geografica, a prescindere dalle dimensioni amministrative degli enti degli Stati e basandosi sull'entità della popolazione residente in ciascuna area. (it) Klasyfikacja Jednostek Terytorialnych do Celów Statystycznych, NUTS (fr. Nomenclature des unités territoriales statistiques, ang. Nomenclature of Territorial Units for Statistics) – standard geokodowania rozwinięty w Unii Europejskiej na potrzeby identyfikowania statystycznych jednostek terytorialnych (zobacz: Europejski Urząd Statystyczny, Eurostat).

(pl) De nomenclatuur van territoriale eenheden voor de statistiek, afgekort NUTS naar het Franse Nomenclature des Unités Territoriales Statistiques, is een samenhangend systeem voor de indeling van het grondgebied van de Europese Unie met het oog op de opstelling van regionale statistieken.

(nl) 地域統計分類単位（ちいきとうけいぶんるいたんい、フランス語: Nomenclature d'unités territoriales statistiques、英語: Nomenclature of Territorial Units for Statistics もしくは Nomenclature of Units for Territorial Statistics、略称:NUTS）は、欧州連合（EU）で用いられている、統計のための地方区画の標準規格である。 (ja) A Nomenclatura Comum das Unidades Territoriais Estatísticas ou Nomenclatura das Unidades Territoriais Estatísticas (designada por NUTS) é uma nomenclatura regional comum, que define sub-regiões estatísticas em que se divide o território dos Estados-Membros da União Europeia. A Nomenclatura foi inicialmente elaborada pelo Eurostat (Serviço de Estatística das Comunidades Europeias) em cooperação com os institutos nacionais de estatística europeus.

A publicação do Regulamento (CE) n.º 1059/2003 do Parlamento Europeu e do Conselho, de 26 de Maio de 2003, deu enquadramento jurídico a esta nomenclatura, As sub-regiões estatísticas estão subdivididas em 3 níveis: Estas sub-regiões devem ser obrigatoriamente utilizadas, pelos Estados-Membros e pela Comissão Europeia, para a recolha, compilação e divulgação a nível comunitário de dados estatísticos. (pt) Номенклатура территориальных единиц для целей статистики (фр. nomenclature des unités territoriales statistiques, NUTS) — стандарт территориального деления стран для статистических целей. Стандарт был разработан Европейским Союзом и детально охватывает лишь страны ЕС.

Территориальные единицы (NUTS-единицы), определяемые данным стандартом, могут соответствовать административно-территориальным единицам стран, но в некоторых случаях данное соответствие отсутствует.NUTS-коды начинаются с двух букв, определяющих страну согласно стандарту ISO 3166-1 «alpha-2» (за исключением кода «UK», используемого вместо «GB» для обозначения Великобритании). Следующая буква NUTS-кода соответствует кодам административных образований согласно стандарту ISO 3166-2.

Второй и третий уровни территориального деления обозначаются каждый одним символом — в первую очередь используются цифры от 1 до 9, если же территориальных единиц на данном уровне больше, то используются также и заглавные буквы латинского алфавита.Помимо подробных кодов трёх уровней территориального деления для стран ЕС данный стандарт определяет коды для всех стран мира. NUTS-коды стран, не входящих в ЕС, начинаются с двух букв, определяющих континент, за которыми следуют две цифры, соответствующие конкретной стране. Кроме того, штаты США, Австралии и провинции Канады имеют свои коды верхнего уровня.NUTS является в некотором роде подобным международному стандарту ISO 3166 и американскому стандарту FIPS (Federal Information Processing Standard).

(ru) 地域统计单位命名法（NUTS，英语：Nomenclature of Territorial Units for Statistics），是歐盟為其成員國的行政區划設立的代號標準。NUTS的分類方法不一定對應該國的行政區劃分類。NUTS以2個英文字母（除了英國以「UK」取代「GB」外，全依ISO 3166-2的標準）開头代表該國，之後的一個阿拉伯數字代表該國的第一級行政區劃，第二個阿拉伯數字代表該國的第二級行政區劃。 (zh) La nomenclature des unités territoriales statistiques est un découpage territorial destiné à faciliter les comparaisons entre pays, ou entre régions, d'un même ensemble.

(fr) تسمية الوحدات الإقليمية للإحصاء أو Nomenclature of Units for Territorial Statistics (NUTS وهو اختصار ل‏(بالفرنسية Nomenclature des unités territoriales statistiques) هو معيار ترميز جغرافي للإشارة للتقسيمات الإدارية للدول لأغراض إحصائية. وقد تم تنظيم وتطوير المعايير بواسطة الاتحاد الأوروبي، وبالتالي فهي تغطي فقط الدول الأعضاء في الاتحاد الأوروبي بالتفصيل. تسمية الوحدات الإقليمية للإحصاء يستفاد منها في آيات الصندوق الهيكلي بالاتحاد الأوروبي. (ar) Klasyfikacja Jednostek Terytorialnych do Celów Statystycznych, NUTS (fr. Nomenclature des unités territoriales statistiques, ang. Nomenclature of Territorial Units for Statistics) – standard geokodowania rozwinięty w Unii Europejskiej na potrzeby identyfikowania statystycznych jednostek terytorialnych (zobacz: Europejski Urząd Statystyczny, Eurostat).

(pl) De nomenclatuur van territoriale eenheden voor de statistiek, afgekort NUTS naar het Franse Nomenclature des Unités Territoriales Statistiques, is een samenhangend systeem voor de indeling van het grondgebied van de Europese Unie met het oog op de opstelling van regionale statistieken.

(nl) 地域統計分類単位（ちいきとうけいぶんるいたんい、フランス語: Nomenclature d'unités territoriales statistiques、英語: Nomenclature of Territorial Units for Statistics もしくは Nomenclature of Units for Territorial Statistics、略称:NUTS）は、欧州連合（EU）で用いられている、統計のための地方区画の標準規格である。 (ja) 地域统计单位命名法（NUTS，英语：Nomenclature of Territorial Units for Statistics），是歐盟為其成員國的行政區划設立的代號標準。NUTS的分類方法不一定對應該國的行政區劃分類。NUTS以2個英文字母（除了英國以「UK」取代「GB」外，全依ISO 3166-2的標準）開头代表該國，之後的一個阿拉伯數字代表該國的第一級行政區劃，第二個阿拉伯數字代表該國的第二級行政區劃。 (zh) The Nomenclature of Territorial Units for Statistics or N

omenclature of Units for Territorial Statistics (NUTS for French Nomenclature des unités territoriales statistiques) is a geocode standard for referencing the subdivisions of countries for statistical purposes.

The standard is developed and regulated by the European Union, and thus only covers the member states of the EU in detail. The Nomenclature of Territorial Units for Statistics is instrumental in the European Union's Structural Fund delivery mechanisms. (en) NUTS (französisch Nomenclature des unités territoriales statistiques) bezeichnet eine hierarchische Systematik zur eindeutigen Identifizierung und Klassifizierung der räumlichen Bezugseinheiten der amtlichen Statistik in den Mitgliedstaaten der Europäischen Union.Sie lehnt sich eng an die Verwaltungsgliederung der einzelnen Länder an. In der Regel entspricht eine NUTS-Ebene einer Verwaltungsebene oder einer räumlichen Aggregation von Verwaltungseinheiten. Eine vergleichbare Systematik gibt es auch in den EFTA- und CEC-Ländern.

(de) NUTS, la Nomenclatura de las Unidades Territoriales Estadísticas (derivado de las siglas en francés de Nomenclature des Unités Territoriales Statistiques), son una serie de demarcaciones territoriales utilizadas por la Unión Europea con fines estadísticos.La nomenclatura NUTS tiene una estructura jerárquica de tres niveles, de las cuales las regiones NUTS-1 representan la jerarquía mayor, más dos niveles de unidades administrativas locales (en inglés LAU) que también se llaman NUTS niveles 4 y 5. (es) La nomenclatura delle unità territoriali statistiche, in acronimo NUTS (dal francese Nomenclature des unités territoriales statistiques) identifica la ripartizione del territorio dell'Unione europea a fini statistici. (it) Номенклатура территориальных единиц для целей статистики (фр. nomenclature des unités territoriales statistiques, NUTS) — стандарт территориального деления стран для статистических целей.

Стандарт был разработан Европейским Союзом и детально охватывает лишь страны ЕС. (ru) A Nomenclatura Comum das Unidades Territoriais Estatísticas ou Nomenclatura das Unidades Territoriais Estatísticas (designada por NUTS) é uma nomenclatura regional comum, que define sub-regiões estatísticas em que se divide o território dos Estados-Membros da União Europeia. A Nomenclatura foi inicialmente elaborada pelo Eurostat (Serviço de Estatística das Comunidades Europeias) em cooperação com os institutos nacionais de estatística europeus.

A publicação do Regulamento (CE) n.º 1059/2003 do Parlamento Europeu e do Conselho, de 26 de Maio de 2003, deu enquadramento jurídico a esta nomenclatura, (pt) Nomenclature of Territorial Units for Statistics (en) Nomenclatura de las Unidades Territoriales Estadísticas (es) Nomenclature des unités territoriales statistiques (fr) Nomenclatura delle unità territoriali statistiche (it) Nomenclatuur van territoriale eenheden voor de statistiek (nl) Номенклатура территориальных единиц для целей статистики (ru) Nomenclatura das Unidades Territoriais Estatísticas (pt) Nomenclature of Territorial Units for Statistics : Wikis (The Full Wiki) Encyclopedia From Wikipedia, the free encyclopedia NUTS redirects here. For the nuclear warfare strategy, see Nuclear utilization target selection (NUTS) . For other uses of the words Nut or Nuts, see Nut .

The Nomenclature of Territorial Units for Statistics (NUTS, for the French nomenclature d'unités territoriales statistiques) is a geocode standard for referencing the subdivisions of countries for statistical purposes. The standard is developed and regulated by the European Union , and thus only covers the member states of the EU in detail. The Nomenclature of Territorial Units for Statistics is instrumental in European Union's Structural Fund delivery mechanisms. For each EU member country, a hierarchy of three NUTS levels is established by Eurostat ; the subdivisions in some levels do not necessarily correspond to administrative divisions within the country. A NUTS code begins with a two-letter code referencing the country, which is identical to the ISO 3166-1 alpha-2 code (except UK instead of GB for the United Kingdom ). The subdivision of the country is then referred to with one number. A second or third subdivision level is referred to with another number each. Each numbering starts with 1, as 0 is used for the upper level. In case the subdivision has more than nine entities, capital letters are used to continue the numbering.

A similar statistical system is defined for the candidate countries and members of the European Free Trade Association , but they are not technically part of NUTS governed by the regulations. In addition to the full three levels for the European Union countries, all other countries have a NUTS code with a two-letter code for a continent and two numbers for the country, and for the USA, Canada and Australia the states, provinces, and territories are numbered separately. There are some anomalies: for example, Gibraltar is listed as being outside the EU with the code EO21; while French Guiana is listed twice, once in France as FR930 and once in South America as AS13. NUTS is thus in some extent similar to the ISO 3166-2 standard, as well as the FIPS 10-4 standard of the United States. Contents Simple English The Nomenclature of Territorial Units for Statistics, (NUTS) for the French nomenclature d'unités territoriales statistiques, is a geocode standard that shows the administrative divisions of countries for statistical purposes. It was made by the European Union , so it only covers the member states of that union in detail.

A NUTS code begins with a two-letter code referencing the country, and is identical to the ISO 3166-1 alpha-2 code (the only difference is UK instead of GB for the United Kingdom ). The subdivision of the country is then displayed by one number. A second or third subdivision level is referred to with another number each. Each numbering starts with 1, as 0 is used for the upper level. In case the subdivision has more than 9 entities, capital letters are used to continue the numbering. In addition to the full three levels for the European Union countries, all countries have a NUTS code with a two-letter code for a continent and two numbers for the country, and for the USA , Canada and Australia the states, provinces, and territories are numbered separately. Some are not easily classified: for example, Gibraltar is listed as being outside the EU with the code EO21; while French Guiana is listed twice, once in France as FR930 and once in South America as AS13. NUTS, in some ways are similar to the ISO 3166-2 standard, as well as the FIPS standard of the United States.

Levels HIV disease burden, cost, and length of stay in Portuguese hospitals from 2000 to 2010: a cross-sectional study | BMC Health Services Research | Full Text BMC Health Services Research Research article Open Access HIV disease burden, cost, and length of stay in Portuguese hospitals from 2000 to 2010: a cross-sectional study Altamiro da Costa-Pereira 1 , 3 BMC Health Services Research201515:144 © Catumbela et al.; licensee BioMed Central. 2015 Received: 21 September 2014 Abstract Background The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hospitals, we examined trends in HIV-related inpatient admissions, length of stay (LOS), Elixhauser comorbidity measures, in-hospital mortality, and mean cost from 2000 to 2010.

Methods The hospital administrative data from inpatient admissions and discharges at 75 public acute care hospitals in the Portuguese National Health Service from 2000 to 2010 were included. HIV-related admissions were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 042.x–044.x. The effect of Elixhauser comorbidity measures on extending the LOS was assessed by comparing admissions in HIV patients with and without comorbidities using the Mann–Whitney U test. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge. Results A total of 57,027 hospital admissions were analyzed; 73% of patients were male, and the mean age was 39 years. The median LOS was 11 days, and the in-hospital mortality was 14%. The mean cost per hospitalization was 5,148.7€. A total of 83% of admissions were through the emergency room. During the period, inpatient HIV admissions decreased by 22%, LOS decreased by 9%, and in-hospital mortality dropped by 12%.

Elixhauser comorbidities increased the median LOS in nearly all admissions. Conclusions Despite small regional variations, a strong, consistent decrease was observed in the hospital admission rate, mean cost, length of stay, and mortality rate for HIV-related admissions in Portugal during 2000–2010. Keywords Advanced HIV infection Administrative data HIV epidemiology Background Since the HIV epidemic emerged in Portugal in 1983, 39,347 cases have been reported, and as of 2010, 16,370 patients have developed advanced HIV infection [ 1 ]. Although the incidence of advanced HIV infection is declining worldwide, the population of persons living with HIV (PLWHIV) continues to rise [ 2 ]. Studies show that the number of HIV-related hospitalizations has decreased in recent years primarily because of the availability of highly active antiretroviral therapy (HAART) [ 3 - 6 ].

This decrease has been accompanied by an increase in the population of PLWHIV worldwide, which was estimated at 34 million people (31.6–35.2 million) through 2010, a 17% increase since 2001 [ 7 ]. HIV-infected individuals are surviving and experiencing longer life expectancies, as well as age-associated comorbidities [ 8 ]. Accordingly, the number of hospitalizations has emerged as an important outcome measure and contributor to healthcare expenditures in this population. To determine the relationship between non-AIDS comorbidities and the progression of HIV disease, in the present study we employed the Elixhauser Comorbidity Index (ECI), which is a comorbidity classification system used to describe and compare patient populations. The ECI can adjust for confounding effects caused by the potential chronic disease burden when a condition is associated with a particular outcome [ 9 ]. In a previous study, we found that the ECI was associated with substantial increases in the frequency and duration of hospitalization, and mortality [ 10 ].

The ECI evaluates 30 comorbidities including HIV; however, we applied the ECI without including HIV as a comorbidity. The impact on the Portuguese population of the reduction in HIV/AIDS-related morbidity and hospitalization in the HAART era has not been thoroughly characterized, and only one known study, which primarily examines mortality, has been published [ 11 ]. An understanding of the factors affecting HIV-related hospitalizations would help optimize resource allocation among regions and could potentially reduce the hospitalization rate for PLWHIV. The Portuguese health system comprises three coexisting systems: the National Health Service (NHS), special social health insurance programs for certain professions (health subsystems), and elective private health insurance. The NHS establishes the right of all citizens to health protection; all citizens have a guaranteed universal right to health care through the NHS. The patient pays a specific fixed cost per use for certain health care services delivered by NHS facilities, but HIV drugs are provided free of charge to all HIV patients [ 12 , 13 ].

Using comprehensive hospital discharge data from Portuguese hospitals, we examined the trends in HIV-related inpatient admissions, length of stay (LOS), mean costs, ECI, and HIV in-hospital mortality from 2000 to 2010. Methods This cross-sectional study examined trends in HIV-related inpatient admissions in Portugal. Hospital administrative data were collected from public acute care hospitals in the Portuguese NHS database maintained by the Central Health System Administration (ACSS). Anonymity was maintained for all hospitals and patients. The dataset included 10,586,118 discharges across 75 hospitals in mainland Portugal from January 2000 to December 2010. The dataset also included the principal diagnosis, defined as the principal condition causing the patient’s admission to the hospital, and up to 19 additional diagnoses.

To capture all of the potential HIV hospital admissions, eligible cases met one of the following criteria: (1) principal diagnosis of HIV/AIDS as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) with diagnosis codes of 042.x–044.x; (2) principal diagnosis of advanced HIV infection (i.e., pneumonia or opportunistic infection as defined by the Major Diagnostic Category 25, “Human Immunodeficiency Virus Infection” [ 14 - 16 ] and a secondary diagnosis of HIV/AIDS; or (3) principal diagnosis unrelated to HIV/AIDS and a secondary diagnosis of HIV/AIDS. Comorbidities were defined as diagnoses other than HIV/AIDS as defined above. The country-wide distribution of hospitals was determined using the Nomenclature of Territorial Units for Statistics II (NUTS II), which is a geocode standard developed by the European Union for referencing the administrative divisions of countries for statistical purposes. The NUTS II level identifies the region by a two-digit or letter-digit code [ 17 ] and is only applied to the mainland regions of Portugal, namely Norte, Centro, Lisbon, Alentejo, and Algarve (Figure 1 ).

Figure 1 PortugalNomenclature of Territorial Units for StatisticsII (NUTS II) regional map. The Norte, Centro, Lisbon, Alentejo, and Algarve regions were included in the present study. From 2000 to 2010, five administrative regulations were issued by the Ministry of Health to assign and update the costs for inpatient admissions according to diagnosis-related groups (DRGs). Two DRGs were used during this period. The mean cost (euros) per hospitalization and the mean yearly cost for each HIV inpatient admission were calculated using both the regulations and discharge DRGs as follows: for the year 2000, regulation 348-B/1998; for 2001–2002, regulation 189/2001; for 2003–2005, regulation 132/2003; for 2006–2008, regulation 567/2006; and for 2009–2010, regulation 132/2009.

The DRG 488–490 was used from 2000–2005, and the DRG 700–716 was used from 2006–2010 (Table 1 ). Table 1 *MCD = Major Category Diagnosis. **DRG = Diagnosis-related group. The hospitalization rate was calculated from the 2000–2010 data on HIV infection in Portugal published by the Direcção-Geral de Saúde [ 18 ]. The mid-year population of PLWHIV was calculated per year by summing the new and old cases, and dividing the result by two. Analysis Variations in the HIV-related hospitalization rates according to clinical characteristics were assessed by univariate analysis and a linear trends test. We first examined the number of HIV-related admissions per year according to the NUTS II region, median LOS, in-hospital mortality, mean cost, admission type, age, and sex. The units of analysis comprised each combination of sex (two categories), age (four categories), NUTS II region (five categories), year (11 categories), LOS, mortality, and mean cost.

The results are represented as the frequency, median, and interquartile range, or as the mean and 95% confidence interval (CI), as appropriate. The impact of the ECI on the LOS was determined by comparing admissions in patients with and without comorbidities using the Mann–Whitney U test at a 0.05 level of significance. Multivariate logistic regression was performed to estimate the odds of having a decreased discharge status according to all HIV-patient and independent variables, including age (first age category served as the standard: 0 to 17 years, 18 to 45 years, 46 to 65 years, and 66 years and older), gender (males compared with females), LOS, and Elixhauser comorbidities (each comorbidity admission was compared with another admission without that comorbidity), with a p-value < 0.05 indicating statistical significance. The variables (comorbidities) included in multivariate logistic regression analysis were selected based on the results of a univariate analysis.

Despite the large number of variables (comorbidities), their use is relevant given their influence on hospital outcomes, particularly on mortality, LOS, and the use of hospital resources. In addition, the study population is quite large and includes many deceased patients; therefore, many cases exist for each predictor and independent variable. The statistical analyses were performed using SPSS version 21 (SPSS IBM, New York, USA). Ethical standards This study employed secondary anonymous data and was performed in accordance with the ethical standards established by the 1964 Declaration of Helsinki and its later amendments. The data were used for scientific research purposes under the Medicine Faculty of University of Porto and Central Health System Administration agreement. Results From 2000 to 2010, 57,027 HIV-related hospital admissions occurred in mainland Portugal. The frequency of admissions decreased during the period, from 5,459 episodes in 2000 to 4,254 episodes in 2010. Additionally, 70% of admissions were male patients, and the mean age increased from 35 years in 2000 to 44 years in 2010.

A total of 70% of all admissions were patients aged between 18 and 45 years. The median LOS decreased from 12 days in 2000 to 10 days at the end of the decade. During this time, 8,203 deaths were reported, and the mortality rate decreased from 14.9% to 13.1% (Table 2 ). Table 2 0.474 (0.281–0.799) *Patients with each comorbidity were compared with patients without that comorbidity. Some Elixhauser comorbidities had no influence on the nonadjusted model and were not included in the analysis, namely rheumatoid arthritis/collagen vascular diseases, psychoses, drug abuse, valvular heart disease, diabetes (both uncomplicated and complicated), complicated hypertension, and hypothyroidism. LOS = length of hospital stay; OR = odds ratio; 95% CI = 95% confidence interval.

Discussion The decline in HIV-related hospital admissions during the final 4 years of the study period (2007–2010) was in opposition to the trend over the first 7 years (2000–2006) in which the number of episodes increased. The HIV incidence appears to have decreased by nearly 50% in one decade. These data indicate success in controlling HIV in Portugal. This success is good considering that the worldwide HIV incidence is also decreasing (nearly 20% over the study period) [ 19 ]. Because HIV is a chronic disease, affected patients experience numerous acute exacerbations. In the present study, 80% of patients were hospitalized because of an acute illness, which highlights the challenge of clinical management and control of HIV. These acute episodes are more common in men because they form the majority of HIV patients in Portugal, as in the rest of Europe [ 20 ]. Worldwide, half of HIV patients are men, though in certain regions, such as Africa and the Caribbean, women predominate [ 7 ].

Over the study decade, the median age increased by 10 years, confirming that many PLWHIV are surviving longer [ 2 , 21 , 22 ]. The overall inpatient LOS decreased during the decade, though the rate increased during the most recent years. This trend may reflect improved access to outpatient care and better adherence to HAART [ 23 ]. Fleishman and Hellinger [ 3 ] studied trends in HIV-related inpatient admissions in seven states in the USA (1996–2000) and found a comparatively shorter LOS (median 6 days) that was half the LOS observed in this study. Characteristics unique to the Portuguese NHS may explain this difference. One reason could be that to discharge a patient in Portugal, several guarantees should be met, such as adequate family support, and continued care at home or at a center providing social assistance; these requirements likely increase the LOS. When the LOS for HIV-related admissions was compared with the LOS for all other admissions, HIV-related admissions showed a greater median LOS than all other admissions. While the LOS for HIV-related admissions decreased compared with all other admissions, this trend was not statistically significant.

Trends in mortality varied across regions, with Norte and Centro differing significantly from Lisbon, Alentejo, and Algarve. Overall, the in-hospital mortality rate decreased by 12%. In the Norte and Centro regions, the decrease between 2000 and 2010 was approximately 40% and 24%, respectively. In Lisbon and Algarve, the mortality rate increased steadily during the period; this result contrasts with the overall decreased mortality over the same period. Many mechanisms may underlie this discrepancy; the treatment methods and patient follow-up protocols are similar across the country, while the absolute frequency of admissions varies by region. The Alentejo and Algarve regions had fewer episodes; therefore, one death may have greater weight than a death in the northern regions where there are more HIV inpatient admissions. Thus, the discrepancy may be due to significant differences in the population itself, rather than in the quality of care. Our results show a substantial decrease in the mortality rate. This decrease might be due to HAART or improved monitoring of HIV patients through outpatient hospital services and health centers in the area of residence.

These data confirm previously published data showing that the HIV-related mortality in Europe has decreased since 1996 [ 24 , 25 ]. The mean estimated cost increased from 2000 to 2001, stabilized with little fluctuation from 2001 to 2005, and decreased steadily from 2006 to 2010. There were no regional differences, and the admission complexity did not appear to vary over the period. Even considering that the prices are set by the Ministry of Health, the mean cost showed a clear decreasing trend, which may be due to the decreased number of cases or improved clinical management over the decade. However, the mean daily cost per admission increased over the same period. These results contradict the lower daily costs reported by Perelman et al. [ 26 ]. Regression analyses for the risk of HIV inpatient mortality were performed for age, sex, LOS, and ECI. The risk of death increased over four-fold with age, but the difference was not significant in patients older than 18 years, as indicated by the overlap in the 95% CIs.

Men had a greater risk of death than women did, and the LOS did not influence the risk of mortality. Most comorbidities increased the risk of death. Metastatic cancer increased the risk three-fold. Several comorbidities did not influence the risk of death, including complicated or uncomplicated hypertension, chronic pulmonary disease, obesity, nutrient-deficiency anemia, psychosis, and depression. This study used comprehensive discharge data compiled in mainland Portugal. Thus, the findings are more generalizable than results based on data from a single hospital. However, this study has limitations, due primarily to the nature of the data [ 27 ]. First, we cannot identify the number of unique patients, the number of times that one patient was hospitalized at a single facility, or the number of years in care. Important clinical information, mainly complementary exams (CD4 cell count, viral load) and the therapy used, was not available. To track the long-term outcomes and quality of care, an electronic database or electronic health record system specially designed to capture these important components of HIV-related care is necessary. Conclusions We found a strong, consistent decrease in the hospital admission rate, cost, LOS, and mortality rate during 2000–2010.

Although the rate of hospitalization directly related to HIV has decreased over time, HIV remains a major cause of hospitalization. Further scrutiny is necessary to explain this trend during the HAART era. The National Health Service appears to have persistently improved outcomes over the previous decade. However, there is an increased need for studies evaluating the constraints on hospital care of HIV/AIDS patients to determine the measures needed to improve the prevention and management of comorbidities in PLWHIV. Declarations Acknowledgments The authors thank the following individuals and institutions: the Central Health System Administration (ACSS) for providing the dataset and the Center for Research in Health Technologies and Information Systems (CINTESIS) workers for their support during this study. Additional files Additional file 1: Table S1. HIV-related inpatient hospitalizations in Portugal by admission type. Table S2. Mean daily cost (euros) per year of HIV inpatient admissions in Portugal. No. = number. Table S3. HIV/AIDS DRG estimated cost per year. DRG = Diagnosis-related group, as described by the Portuguese Ministry of Health. Table S4. Inpatient admissions and mortality according to HIV-related and -unrelated principal diagnoses. PD = principal diagnosis.

Competing interests The authors declare that they have no competing interests. Authors’ contributions EC wrote the manuscript and performed the statistical analysis. AF coordinated the statistical analysis and helped to draft the manuscript. FL participated in the statistical analysis and helped to draft the manuscript. MCTM helped to draft the manuscript. CC participated in the statistical analysis and helped to draft the manuscript. AS helped perform the study and draft the manuscript. ACP conceived and coordinated the study, and helped to draft the manuscript. All authors read and approved the final manuscript. Authors’ Affiliations Department of Infectious Diseases, Faculty of Medicine, University of Porto (7) Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro References Jorge INdSDR. Infecção VIH/SIDA: A Situação em Portugal a 31 de Dezembro de 2010. In; Book Infecção VIH/SIDA: A Situação em Portugal a 31 de Dezembro de 2010 (Editor Instituto Nacional de Saúde Doutor Ricardo Jorge, IP.), 142 edition.

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Question: What is the acronym developed by the European Union as the geocode standard for referencing the administrative divisions of countries for statistical purposes?
Answer: NUTS