Brussels Capital Region Research Articles

Patterns of alcohol use in Belgium, 2013-2020

Abstract Despite numerous efforts worldwide to reduce the harmful effects of alcohol, its impact on health remains significant, contributing significantly to the loss of healthy life years. In Belgium, alcohol use is still a major public health concern, ranking among the highest in alcohol consumption across Europe. This study aims to use available nationally representative data to estimate and evaluate the time trends of alcohol use patterns in Belgium from 2013 to 2018. We used repeated cross-sectional survey data from the Belgian Health Interview Survey (BHIS), which includes self-reported alcohol use and sociodemographic data, to create a time series of annual consumption from 2013 to 2018. This included current and former drinkers, and lifetime abstainers by year, sex, region, and age groups. We applied a Bayesian hierarchical model, using the Integrated Nested Laplace Approximation to create the time series and forecast trends for 2020. In Belgium, the prevalence of current drinking remained at a similar level of 80% from 2013 to 2020, with similar rates observed in the Flemish (FL) and Walloon (WA) regions. However, the Brussels-Capital region (BR) had a slightly lower prevalence of 70%. Trends remained relatively stable across all regions during this period. The national level of former drinkers increased from 5% in 2013 to 8% in 2020, with BR and FL showing similar increases, while WA experienced a decline. Abstainer rates rose from 15% in 2013 to 19% in 2020 nationally, with varying increases in each region. Specifically, abstainer rates in FL increased from 13% to 17% and in WA from 14% to 20%, while BR saw an increase from 19% to 22%. Overall, declining trends were evident, with men exhibiting higher prevalence rates across all categories. Time trends from the BHIS reveal consistent and high use of alcohol in Belgium over 7 years, emphasizing the ongoing public health challenge. Urgent policy interventions are needed to reduce the impact of alcohol on health Key messages • Alcohol use in Belgium is still a pressing public health issue, with high prevalence rates of current drinking in the population. Different patterns of alcohol use can be seen between regions. • Understanding the role of alcohol on population health as an attributable burden can improve health monitoring.

Using digital technologies and applications in midwifery practice in Belgium: A descriptive cross-sectional study

IntroductionOver the past two decades, there has been a dramatic increase in the use of digital technologies within healthcare and also in midwifery. However, scarce literature exist on the use of digital technologies and applications in midwifery practice particularly in the Belgian setting. AimTo map the use of digital technologies and applications by midwives in various settings, encompassing hospitals, primary care, and educational institutions in Belgium. MethodsA descriptive cross-sectional design was used to collect data via an online questionnaire targeting at midwives working in the Flemish region, Walloon region, or Brussels-Capital region. Midwives were either Dutch-speaking or French-speaking (n = 212). The semi-structured questionnaire addressed three domains: (1) socio-demographics, (2) employment information (3) the use of digital technology, including the level of comfort with technology. Qualtrics© program was used for managing data and SPSS v28.0© for data analysis using descriptive statistics, Chi² analysis, and independent sample t-test. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. ResultsAmong respondents, 58% reported the use of digital technologies and applications, with electronic health records (89.6%), electronic prescriptions (65.6%), and remote patient monitoring (51.2%) commonly utilized. Sensor technology (7.2%), mixed care (3.8%), care robots (2.5%), and wearable devices (1.9%) were very rarely used. The target groups for these digital technologies and applications generally encompass all stages of the perinatal period. Midwives felt overall highly confident with these technologies. Younger participants and those with a Master's or PhD degree exhibited greater comfort scores in digital technology use. No significant relationships were observed between socio-demographic characteristics and the adoption of digital technology. ConclusionThe results highlight the potential for incorporating digital technologies and applications into various midwifery care settings. Addressing barriers and enhancing usability can optimize technology integration, contributing to personalized high-quality care, ultimately improving perinatal health outcomes.

The MAMCABM framework for the evaluation of mobility decision‐making problems: theory and practice

AbstractIn the constantly evolving transportation and mobility industry, objective and reliable decision‐support systems (DSS) are crucial for addressing complex issues such as transit planning, mode selection, and policy formulation. This paper presents multiactor multicriteria analysis plus agent‐based modeling (MAMCABM), a novel framework that combines multiactor multicriteria analysis (MAMCA) and agent‐based modeling (ABM) to provide a comprehensive DSS. MAMCA excels in facilitating stakeholder‐centric evaluations, while ABM, enhanced by data analytics, adeptly models intricate, interactive systems. The combination of MAMCA and ABM enhances adaptability and precision in decision making. This integration utilizes data analytics and optimization algorithms to provide solutions that consider multifaceted criteria and diverse stakeholder perspectives in dynamic and uncertain contexts. The study outlines the mathematical underpinnings of MAMCABM and offers a practical guide for its implementation. The framework's efficacy is demonstrated through an empirical investigation that addresses mobility challenges in the Brussels Capital Region of Belgium. Compared to the previous study, this approach leverages simulated quantitative data alongside qualitative judgments from stakeholders. The integration of a consensus‐reaching algorithm further enhances the robustness of outcomes and effectively addresses uncertainties.

Museum educators’ views on digital museum education: opportunities and challenges

ABSTRACT The COVID-19 pandemic has accelerated the digitalisation of museum education. To date, most research has focused on visitors’ experiences with and museums’ management of digital museum education. This leaves the voice of museum educators underresearched. Museum educators, however, are the main drivers of this digital transformation. Therefore, this study explores the voice of museum educators. Semi-structured online interviews were conducted with twelve museum educators working in museums in the Brussels Capital Region (Belgium). We identified opportunities and challenges of digital museum education related to three key stakeholders of museums, i.e. museum visitors, museum educators, and museum institutions. Partnerships seemed key to overcome challenges in developing digital museum education. By exploring museum educators’ experiences, we provide a broader and multi-layered understanding of digital museum education on which practice and research can build further.

An exploratory analysis of the development and implementation of urban animal welfare policy in public spaces for four common species: Cats, dogs, pigeons, and foxes in the Brussels Capital Region

ABSTRACT This study aims to understand urban animal welfare policy development and implementation for four species in public spaces: cats (Felis catus), dogs (Canis familiaris), pigeons (Columbia livia domestica), and foxes (Vulpes vulpes). Our exploratory research offers an overview of the perspectives of all involved municipal and police officers and their challenges in a metropolitan urban context, the Brussels Capital Region in Belgium. We conducted semi-structured interviews with 35 participants from 19 municipalities and six police zones of the region. Additionally, we organized two focus groups consisting of representatives from municipalities, police zones, and nongovernmental organizations. Afterward, we analyzed the data thematically, leading to the identification of six policy and six practice recommendations. These recommendations can help advance the notion of urban animal welfare for the four species from a multispecies perspective.

The effect of spatio-temporal sample imbalance in epidemiologic surveillance using opportunistic samples: An ecological study using real and simulated self-reported COVID-19 symptom data

Open surveys complementing surveillance programs often yield opportunistically sampled data characterised by spatio-temporal imbalance. We set up our study to understand to what extent spatio-temporal statistical models using such data achieve in describing epidemiological trends. We used self-reported symptomatic COVID-19 data from two Belgian regions, Flanders and the Brussels-Capital Region. These data were collected in a large-scale open survey with spatio-temporally imbalanced participation rates. We compared incidence estimates of both self-reported symptoms and test-confirmed COVID-19 cases obtained through generalised linear mixed models correcting for spatio-temporal correlation. We additionally simulated symptom incidences under different sampling strategies to explore the impact of sample imbalance, sample size and disease incidence, on trend detection. Our study shows that spatio-temporal sample imbalance generally does not lead to bad model performances in spatio-temporal trend estimation and high-risk area detection. Except for low-incidence diseases, collecting large samples will often be more essential than ensuring spatio-temporally sample balance.

Urban renewal and heritage in Brussels, Belgium: participation as the keystone

ABSTRACT Brussels, like many European capitals, is undergoing constant change. The changing use of its districts is giving rise to new problems. To revitalise neighbourhoods in difficulty, Brussels-Capital Region has for many years put in place a number of tools, including Sustainable Neighbourhood Contracts, Urban Renewal Contracts and other specific urban policies. The Regional Administration is responsible for the implementation of a large part of the urban policies and the Urban Renewal Department coordinates the programmes which are implemented by the local authorities concerned, with technical expertise of local consultancies and associations. Our paper describes some on the urban renewal and heritage programmes and provides some examples of finished schemes.

Fusion of multi-temporal PlanetScope data and very high-resolution aerial imagery for urban tree species mapping

Detailed assessment of the ecosystem services provided by urban green spaces requires data on urban tree species. While many approaches for mapping of urban trees from remotely sensed data have been proposed, the fusion of multi-temporal satellite imagery with very high resolution orthophotos remains relatively underexplored. In this research, we assess the potential of a multimodal deep learning approach with intermediate data fusion for classifying common tree species found in the Brussels Capital Region. Our method combines two image sources: (a) multi-temporal PlanetScope data and (b) high-resolution aerial imagery. To evaluate the contribution of each image source, we separately train and assess each branch of the network. Both image sources demonstrate the ability to predict prevalent tree species with high accuracy. However, the fusion of the two image sources yields the best results, achieving an overall accuracy of 0.88 for the five most common tree species in the region. Our approach is compared to two conventional machine learning methods: a random forest (RF) and a support vector machine classifier (SVM) and outperforms both with a 11 percentage point increase in overall accuracy over RF and a 10 percentage point increase over SVM. Increasing the number of species from five to thirteen, including all species with more than 500 tree samples, results in a marginal decrease in accuracy (from 0.88 to 0.84). Overall, our deep learning approach demonstrates its efficacy in classifying common tree species in urban settings and provides a foundation for a comprehensive quantification of ecosystem services offered by urban trees through remote sensing data.

Towards architectural design empowerment: analysis of the Solidary Mobile Housing project’s rationale through Theory of Change in Direct Design Empowerment Framework

ABSTRACT The politics of participatory design implicates empowerment as the core value of the approach. This study centres on empowerment as its primary focus and seeks to address the gap in literature by exploring the implications of the phenomenon in architectural design. Direct Design Empowerment Framework (dDEF) is briefly introduced and applied to analyse the end user empowerment in the Solidary Mobile Housing (SMH) case – a Living Laboratory on the co-creation of an alternative, temporary, or transitional housing solution for the Brussels-Capital Region. Besides revealing that the SMH proposal can be considered promising in terms of end user empowerment, the critical discussion of the findings also reveals a lack of clarity in defining empowerment in architectural design. It is argued that an explicit and systematic evaluation is needed for identification and more radical envisioning of empowerment facilitating power sharing and mutual learning between all actors. Finally, as a secondary outcome, the study presents observations on the efficacy of dDEF in evaluating empowerment. The study concludes by revisiting the research questions, discussing its limitations, and suggesting for future research directions.

Identification of compound drought and heatwave events on a daily scale and across four seasons

Abstract. Compound drought and heatwave (CDHW) events can result in intensified damage to ecosystems, economies, and societies, especially on a warming planet. Although it has been reported that CDHW events in the winter season can also affect insects, birds, and the occurrence of wildfires, the literature generally focuses exclusively on the summer season. Moreover, the coarse temporal resolution of droughts as determined on a monthly scale may hamper the precise identification of the start and/or end dates of CDHW events. Therefore, we propose a method to identify CDHW events on a daily scale that is applicable across the four seasons. More specifically, we use standardized indices calculated on a daily scale to identify four types of compound events in a systematic way. Based on the hypothesis that droughts or heatwaves should be statistically extreme and independent, we remove minor dry or warm spells and merge mutually dependent ones. To demonstrate our method, we make use of 120 years of daily precipitation and temperature information observed at Uccle, Brussels-Capital Region, Belgium. Our method yields more precise start and end dates for droughts and heatwaves than those that can be obtained with a classical approach acting on a monthly scale, thereby allowing for a better identification of CDHW events. Consistent with existing literature, we find an increase in the number of days in CDHW events at Uccle, mainly due to the increasing frequency of heatwaves. Our results also reveal a seasonality in CDHW events, as droughts and heatwaves are negatively dependent on one another in the winter season at Uccle, whereas they are positively dependent on one another in the other seasons. Overall, the method proposed in this study is shown to be robust and displays potential for exploring how year-round CDHW events influence ecosystems.

Out of Many, One? Exploring Ethnolinguistic Identity Appeals in the Brussels Capital Region

Abstract Consociationalism promises to resolve tensions among groups in deeply divided societies by constructing shared identity that transcends ethnic divisions. Yet there is no guarantee that this will happen, and empirical studies testing this claim yield inconsistent results. We examine the extent to which political parties appeal to shared identities within a consociation, focusing on the Brussels Capital Region (BCR) in Belgium. The BCR constitutes a regional consociation aimed at addressing divisions between Dutch and French speakers. Based on a quantitative analysis of party programs, and a qualitative analysis of thirty interviews with Brussels MPs, our findings indicate that parties do indeed appeal to a common sense of belonging, often on issues that have a low ethnolinguistic salience. When addressing contentious community matters, however, we observe that Dutch-speaking parties (especially ethnic outbidders) prioritize their own linguistic group identity more than Francophone parties.

Crossing the Rubicon: Strategies and Motivations behind Cross-ethnolinguistic Vote-seeking in the Brussels Capital Region

How and why do political parties seek cross-ethnolinguistic support within a consociation? This article constitutes a thematic analysis of 30 interviews undertaken with MPs from the Brussels Capital Region (Belgium). It shows how both strategic and principled considerations underpin the logic of parties appealing to the other language group. I identify six strategies: employing customized communication, cultivating visibility, fostering cross-ethnolinguistic interactions, presenting alternative party offerings, establishing a ‘Brussels’ image, and navigating voters. However, in adopting these, they encounter (in)formal and practical obstacles. These findings are significant, as seeking cross-ethnolinguistic support is expected to mitigate tendencies toward outbidding and extremism.

Addressing Local Water Security through Green Infrastructure Implementation: A Review of Urban Plans in Monterrey, Mexico, and Brussels, Belgium

Green infrastructure (GI) is increasingly linked to urban water management and can contribute to achieving water security in communities. This research uses a variation-finding comparative approach to recognize how far GI solutions are currently used to address water security in the urban developments of Monterrey City, Mexico, and Brussels-Capital Region, Belgium. A comparative content analysis of seven related urban development/sectoral plans is conducted using ATLAS.ti 9 software. The results depict the overall distribution of GI implementations, their typologies and spatial scales, water-security aspects that are addressed by GI, and the related definitions in the plans. In general, our analysis does not present a promising situation for the Monterrey case, although it reveals that policymakers have started to use GI in urban plans to address water security. Considering Brussels’ conditions, although GI solutions are much more frequent and advanced than in Monterrey plans, the region cannot be considered a frontrunner of GI policies. Comparing these two remarkably diverse areas is beneficial to illuminate universal aspects of planning, as the method provides an opportunity to gain insight from a multi-city perspective, whether developed or developing, showing the potential areas to advance urban policies.

The exploration of professional midwifery autonomy: Understanding and experiences of final-year midwifery students

BackgroundThe concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the understanding and experiences of students regarding midwifery autonomy are relatively unknown. ObjectivesThis study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students. MethodsA qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis. ResultsUpon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy. ConclusionsOur study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.

The widespread implementation of teleworking in the Brussels-Capital Region

La crise du Covid-19 a profondément bouleversé notre manière de travailler. En effet, pendant quelques mois, une large partie de la population belge a expérimenté, souvent pour la première fois, le télétravail complet. D’abord envisagé comme une façon de limiter les contacts, celui-ci s’est progressivement ancré durablement, en s’intensifiant là où il était déjà pratiqué et en s’étendant à de nouveaux postes et secteurs autrefois non concernés. Avec cette généralisation, des effets sociétaux importants sont à prévoir, notamment à Bruxelles, où la pratique du télétravail est la plus intense. Il convient de les anticiper pour s’y préparer et s’y adapter au mieux. Cet article s’inscrit dans le cadre d’un projet d’évaluation prospective de la dette sociale liée à la généralisation du télétravail à Bruxelles à l’horizon 2050. Plus spécifiquement, au travers de la littérature et des données récentes, cet article analyse les effets potentiels du télétravail à Bruxelles en matière de bien-être, d’économie et d’emploi, d’immobilier, de mobilité ainsi que de finances publiques.

Invisible to the state. An initial estimate of “administrative disappearances” in the Brussels-Capital Region

En Belgique, la domiciliation donne accès aux droits fondamentaux par l’inscription des personnes au Registre National. Le Registre National centralise toutes les données qui sont recueillies par les communes. L’invisibilisation administrative a donc des conséquences directes sur la jouissance des droits sociaux. Elle a trois origines distinctes : l’absence d’inscription, la radiation, la suppression de personnes du Registre National. Au départ de l’analyse des données du Registre National, cet article s’intéresse aux phénomènes d’« invisibilisation administrative », c’est-à-dire à la disparition ou la radiation, volontaire ou involontaire, des registres administratifs. Une analyse anthropologique des pratiques administratives concernant la domiciliation des personnes introduit l’article qui est poursuivi par une quantification et une spatialisation du phénomène d'invisibilisation administrative et enfin une enquête sociologique auprès des personnes victimes d’invisibilisation administrative éclaire leurs parcours d’exclusion.

Vaccination Covid-19

Introduction: After the first vaccination campaign, a low vaccination coverage was observed in Brussels. This is linked to an accumulation of factors such as limited accessibility, confidence in the effectiveness and safety of the vaccine or in the public institutions combined with complicated transport solutions and a lack of vaccinators. These are significant barriers to improving immunization coverage, particularly in vulnerable neighborhoods.
 In order to increase coverage and also in the perspective of vaccinating everyone (vacci4all project), Common Community Commission (COCOM) has decentralized vaccination through temporary initiatives: local antennas, mobile teams, door-to-door visits, GP’s, awareness-raising by pharmacists, call-centers,...
 The results have reinforced the idea of decentralization to reach the most vulnerable. The idea of vaccination in pharmacies was explored, bringing new perspectives regarding long-term management.
 Method: 
 1. Pharma-on-tour
 Through an application system and the establishment of quality criteria, 5 pharmacies with
 experience in vaccination centers are integrated into the pilot project: doctors come to the
 pharmacy to vaccinate patients previously sensitized by the pharmacist. The pharmacists prepare the vaccines; the doctors administer them. The project is financed by the Brussels-Capital Region (BCR).
 2. Vaccipharma
 A few days after the publication of the March 11, 2022 law allowing pharmacists to vaccinate, the
 Vaccipharma project is launched: vaccination by pharmacists starts in 5 pharmacies that meet the quality requirements.
 3. Timesheet
 Without a remuneration framework, the acts of preparation and vaccination are still
 covered by the region on the basis of an hourly rate determined by Timesheets which are
 filled in by the pharmacists who keep track of the acts related to the vaccination which helped determine a remuneration in accordance with reality/practice.
 4. Implementation of the NIHDI remuneration framework and extension to the entire BRSince September 1, 2022, pharmacists can be remunerated for the acts of preparation of vaccine doses and vaccinations by the NIHDI. Any person, insured or not, can be vaccinated in a pharmacy.
 In addition to the vaccination in the pharmacy, the COCOM takes care of the delivery to the first line as well as the preparation and delivery to the nursing homes and communities.
 5. Extension of the project from 28 to 135pharmacies
 All Brussels municipalities have vaccinating pharmacies. Each pharmacy was inspected and given training to ensure the respect of the government's quality requirements.
 Results/Lessons learned: The need to focus on decentralized vaccination initiatives that combine proximity, quality and trust was reaffirmed. This is demonstrated by the fact that the preferred location for patients seeking a primary vaccination is the pharmacy. 
 This promising and sustainable project enables a local supplying and is a catalyst for first line vaccination in an infrastructure that provides a quality of reception and service in a place familiar to the public, with a very interesting cost-benefit-quality ratio. The individual approach and direct communication can increase vaccination coverage, particularly in vulnerable neighborhoods. A survey of patients reveals a high level of satisfaction both in terms of reception, booking, information received, privacy, proximity, ease, speed, accessibility and in the trust-based relationship.

Physical Activity on Referral in Brussels

Since 2017, Huis voor Gezondheid has been coordinating the Physical Activity On Referral project in Brussels with the approval of the Flemish Government. The aim of this project is that doctors motivate their patients to adopt a more active lifestyle and that people from Brussels move more. If the patient is sufficiently motivated, the doctor can refer this patient to the Physical activity on referral-coach via a referral letter. The coach motivates and supports the patient on their way to a more active lifestyle. He does this through motivational interviewing and by sounding out which low-threshold exercise initiatives the patient wants to integrate into his daily life.
 In principle, every inhabitant of the Brussels-Capital Region can be referred to the coach. The project is mainly intended for people with an inactive lifestyle and for people with certain health risks or health problems for which exercise has already been shown to have a positive influence. Children cannot be referred, interested persons must be at least 18 years old.
 The project pays attention to the vulnerable population by mapping the local low-threshold exercise offer and by providing lower rates for people with an increased allowance for the coach. In Brussels especially this group is important to include and to pay extra attention to.
 In short, this project focuses on prevention, on keeping people healthy for as long as possible through integrated care.
 Scope of the project: The project currently is active in 4 municipalities in Brussels: Anderlecht, Sint-Jans-Molenbeek, Schaarbeek and Brussels-city.
 Partners: Physical Activity On Referral starts from a local intersectoral network in which local and regional partners from different sectors are represented such as local authorities, doctors, health and welfare services, providers of low-threshold exercise options, organizations that reach vulnerable groups,…. Each municipality consists of an intersectoral network. These regional partners are crucial for the succes of the project. Without all these partners, we would not be able te reach as many citizens as we do now.
 The interventions: Every year, Huis voor Gezondheid organizes several intersectoral local antennas within each municipality to discuss the progress of the project. In addition, Huis voor Gezondheid is also organizing a major event to bring all partners together of the project.
 Results: Since 2017 to the end of 2021 we have reached a total of 464 patients
 
 2017: 14 patients
 2018: 115 patients
 2019: 154 patients
 2020: 85 patients
 2021: 96 patiënts
 
 Learnings and next steps: The evaluations of patients and doctors show that patients move more after following a trajectory with the coach. In 2023 we will implement the project within the municipality of Jette.

Tree View Assessment: Survey of Two Municipalities Located in the Brussels Capital Region

Abstract Background Recent literature has highlighted the importance of visual accessibility to nature to reduce stress, anxiety, or depression amongst others. However, green visual accessibility is yet rarely considered in urban policy implementations. Reasons behind this are manifold, and include the challenges associated with the measurability of green views which require data-intensive pedestrian view computations, and assessment methods are yet to be agreed upon. Methods Two methods, Street View Images (SVI) and semantic classification, and geospatial viewshed analysis, were used to compute street level tree views. All street views contained within 2 municipalities from the Brussels Capital Region (BCR) have been studied. Using the SVI method, 15 green view indicators have been proposed. Using the viewshed analysis, the tree view area ratio (TVar) from each SVI geo-location has been computed. The independence between the indicators was evaluated, and using a random forest model, the principal SVI indicators to describe the TVarhave been studied. Results The variability explained by the random forest model was approximately 60% to 70%. The SVI indicators related to the horizontality of green infrastructure and tree canopy explained most of TVar. The results also reveal the tree canopy differences between both municipalities. Conclusions SVI tree view indicators provide acceptable predictions of the TVarwhich could be particularly useful for municipalities with no access to detailed geospatial data. The 30% to 40% of the unexplained variability, could be related to errors derived from the tree canopy geospatial layer, differences in the data collection dates, or geolocation errors of the SVIs.

Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study.

To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels-Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs). Cross-sectional analyses of yearly hospital administrative data. All Belgian hospitals and discharge destinations, focusing on LTCFs. All individuals from the Brussels-Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572). We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections. Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22-1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85-0.90). Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.