Statistics Portugal Research Articles

How ambient NO2 impacts the mortality burden of ischemic heart disease in Portugal (2011-2021)?

Abstract Background Air pollution is a major environmental risk to human health, contributing to premature death and disease. Nitrogen dioxide (NO2) is a pollutant of significant public health concern, associated with increased risks of all-cause mortality, particularly in cardiovascular and respiratory deaths. In 2021, NO2 exposure exceeding the World Health Organization Air Quality Guidelines resulted in 69,000 deaths in the European Union. This study aims to estimate the impact of ambient NO2 exposure on ischemic heart disease (IHD) in Portugal, from 2011 to 2021, estimated in years of life lost (YLL). Methods Data on ambient NO2 levels were obtained from the Portuguese Environment Agency’s online database QualAr. Only monitoring stations that reported valid data for at least 75% of the time in a year were considered. The number of IHD mortality cases from 2011 to 2021 was sourced from Statistics Portugal. The burden of IHD attributed to NO2 exposure was estimated in YLL for the Portuguese population aged 25 years and older, categorized by five-years age groups, regions of mainland Portugal and sex, using the population attributable fraction (PAF). Results Between 2011 and 2021, mainland Portugal experienced a declining trend in NO2 mean levels, with occasional fluctuations. Regarding IHD YLL attributed to NO2 exposure, the same trend was followed with an overall decline over the study period. In total, 94,843.75 (95% CI 53,408.35-134,766.17) IHD YLL were attributed to NO2 exposure, with an estimated number of IHD YLLs higher for males than for females. Conclusions These findings underscore the significant impact of air pollution on human health. Despite an overall reduction in YLL across mainland Portugal, persistent health effects emphasize the need to reduce NO2 concentrations, with informed decision-making being crucial to mitigate these impacts and protect public health. Key messages • Ambient NO2 exposure significantly impacts ischemic heart disease mortality in Portugal. • These estimates underscore the necessity of well-informed decision-making to safeguard public health.

Monthly Tracking of Infant Mortality in Portugal: Post-COVID Trends

Abstract Background The Infant Mortality Rate (IMR) is a fundamental health indicator that reflects the overall well-being of populations. Recognizing the need for more timely data to inform public health strategies, the authors have presented a novel method for monitoring IMR monthly instead of traditional annual reporting. Our work aims to increase further the robustness of a novel method for monitoring IMR monthly. Methods This new approach leverages the Portuguese E-Death Certification System (SICO) and Statistics Portugal (2016-2024) data. It provides the most recent insights into IMR trends in Portugal, highlighting the post-pandemic period. This method allows for the analysis of cumulative deaths under one year of age against live births over the previous 12 months, offering a more responsive metric to guide interventions. Results The updated analysis reveals a continued pattern influenced by the dynamic public health landscape of the COVID-19 pandemic, including the phasing out of restrictions and the end of mandatory mask usage. The pandemic has significantly impacted IMR trends, with Portugal experiencing a decline in IMR during the stringent phases, reaching historically low levels. This trend slightly reversed following the lifting of restrictions, underscoring the urgent need for understanding the complex interplay between public health policies and infant mortality. In the post-pandemic period, the IMR increased until October 2023, showing a later (up to February 2024) global decreasing trend within the range of 2.5 and 2.9 deaths per 1000 live births. Conclusions Recent updates confirm the effectiveness of real-time IMR monitoring as a vital tool for policymakers and health professionals. Portugal’s experience underscores the importance of real-time health indicators in managing public health crises. It stresses the need for further research to understand factors affecting IMR and to continue reducing infant mortality. Key messages • COVID-19 restrictions correlated with a historical low in Portugal’s IMR, showcasing the impact of stringent public health measures. • Post-lockdown, the rise in IMR after the phasing out COVID-19 restrictions and later stabilization underscores the challenges and the necessity for dynamic health policies.

REGIONAL PRODUCTION PROFILE AND SUSTAINABILITY: CASE STUDY OF PORTUGAL

Objective: The study of Portugal's productive profile, at the level of the NUT III regions and on an evolutionary basis, in order to obtain a picture of the country at two different times 20 years apart. We also sought to establish a relationship between these profiles and productivity. Theoretical Framework: Review of the literature on productive specialisation and development, as well as other empirical work already carried out. Method: Construction of location indicators for productive activities, regional specialisation and relational analysis with productivity indicators. The data used, namely GVA and Employment relating to 10 activity branches/25 NUT III, has been made available by STATISTICS PORTUGAL through request. Results and Discussion: The results show a profile of Portugal in which the primary sector predominates in the interior of northern Portugal and in Alentejo, the secondary sector in the north coast and in the centre, and the tertiary sector is strongly represented in Lisbon and Porto. This profile is associated with different productivities and in evolutive terms there are signs of some changes, but still not significant. Research Implications: The sustainability of regions depends, among others, on their productive profile. As a matter of fact it is the productive sector that generates income and employment, the key variables in the socioeconomic components of sustainability. The way in which economic activities are concentrated and in which agglomeration economies can be generated are factors that can influence this development. Originality/Value: Knowledge of the evolution of a country's productive profile and how activities with different productivities fit in could contribute to a more efficient policy of intelligent specialisation and guarantee a path to sustainable development.

Monthly Analysis of Infant Mortality Rate in Portugal during the COVID-19 Pandemic: Insights from Continuous Monitoring.

The COVID-19 pandemic significantly impacted global public health. Infant mortality rate (IMR), a vital statistic and key indicator of a population's overall health, is essential for developing effective health prevention programs. Existing evidence primarily indicates a decrease in IMR during the COVID-19 pandemic. We conducted a national-level analysis to calculate IMR and describe its course over the years (from 2016 until 2022), using a month-by-month analysis. Data on the number of deaths under one year of age was collected from the Portuguese E-Death Certification System (SICO), and data on the number of monthly live births was obtained from Statistics Portugal. The IMR was calculated per month, considering the previous 12 months' cumulative number of deaths under one year of age and the number of live births. In Portugal, the IMR decreased before and during the COVID-19 pandemic. The lowest values were observed in September and October 2021 (2.15 and 2.14 per 1000 live births, respectively). The IMR remained below the threshold of three deaths per 1000 live births during the pandemic's critical period. Portugal has achieved remarkable progress in reducing its IMR over the last 60 years. The country recorded its lowest-ever IMR values during the COVID-19 pandemic. Further studies are needed to fully understand the observed trends.

Years of life lost associated with COVID-19 deaths in Portugal: two years of pandemic

Abstract Background The impact of the COVID-19 pandemic on the Portuguese population is still underexplored. Therefore, the characterization of years of life lost (YLL) due to this epidemic may provide relevant data for establishing effective strategies in future epidemics. The aim of this study was to calculate YLL associated with COVID-19 deaths in Portugal between 2020 and 2022. Methods This was an observational, cross-sectional study. Data on the average resident population and life expectancy at birth by age group and sex were obtained from Statistics Portugal (INE) and GBD 2019 standard life-table, respectively. Data on COVID-19 deaths were extracted from the Directorate-General of Health's (DGS) reports. YLL was calculated as the number of COVID-19 deaths multiplied by standard life expectancy at the age of death, globally, by sex and age group. YLL was calculated by 100,000 population and age-standardized. Results Between 2020 and 2022, 3413013 cases of COVID-19 were reported in Portugal, of which 21342 (0.6%) eventually died of the disease. The number of deaths by sex was similar globally or by age group. Globally, the YLLs estimated for COVID-19 in Portugal were 309383,8. YLLs were higher for males than for females for most age groups except of age groups 10-19 yrs (76.56 vs 153.11) and > 80 yrs (58710.88 vs 68491.44). YLLs age-standardized also showed a steady increase as we progressed in the age group [from 3.25 (0-9 yrs) to 885.54 (>80 yrs)], in which from the 50-59 yrs age group onwards we observed a steeper slope of increase in YLLs. Conclusions COVID-19 has had a major impact on mortality rates in Portugal, with this impact being greater in the older population, especially in people aged over 70 years. Also, males presented higher YLLs than females, with this difference increasing substantially as age increases. These insights can be useful in terms of public health as the disease progresses to an endemic phase. Key messages • COVID-19 has had a major impact on mortality rates in Portugal. • Calculating YLLs associated with COVID-19 in Portugal provides relevant data for establishing effective strategies in future epidemics.

The Social Economy in Portugal: legal regime and socio-economic characterization

The main objective of this article is to provide an updated portrait of the Social Economy sector in Portugal. For this purpose, we first analyse how in Portugal the concept of Social Economy has been defined and delimited, particularly by legal means. The difficulties in establishing clear and unquestionable boundaries are highlighted, as well as the observation of the concept from the diversity that composes it, both in terms of guiding principles and of groups of entities that integrate this sector. Subsequently, a quantitative portrait of the Portuguese Social Economy is drawn, with the most recent data, made public in 2019 and for 2016, as a source. These data result from work done by the National Statistics Institute (INE - Statistics Portugal) through the Social Economy Satellite Account. In addition to the main general indicators of the sector (number of units, gross value added, main activities, groups of entities, total and paid employment), a specific analysis by groups of entities is also carried out. By making use of Satellite Account to draw this picture, we aim to provide conceptually structured statistical information with a form and content that may facilitate its subsequent use in the context of broader studies, both diachronic analysis as well as international comparisons.

Ecological factors associated with areas of high tuberculosis diagnosis delay

ObjectiveWe aimed to identify areas of high tuberculosis (TB) diagnosis delay in mainland Portugal in 2017 and ecological factors associated with these areas. Study designThis was an ecological study. MethodsWe considered all notified pulmonary TB cases from the Portuguese National Tuberculosis Surveillance System in mainland Portugal. Diagnostic delays were calculated at the municipality level. Demographic variables, proxies for TB awareness, health services capacity indicators, and socio-economic variables were included and extracted from official databases, such as Statistics Portugal, Ministeries, Foreigners and Border Services. We used spatial analysis to identify areas of high delay in 2017 and logistic generalised additive models to identify ecological factors associated with the identified cluster. ResultsWe identified an area of high delay in 2017 in the South region of the country. Overall, municipalities with a smaller population density, smaller proportion of unemployed, fewer health centres and higher old-age dependency ratio, proportion of men, TB incidence, proportion of immigrants and high school dropout had a higher probability of belonging in a high delay area. ConclusionThe role of primary health care in TB diagnosis should be further explored. Interventions should address factors interplaying at the local and individual levels. Policies influencing social and health conditions, leading to changes in individual behaviour, can lead to sustained improvements over time.

The benefits of a unit dose system in oral antibiotics dispensing: Azorean hospital pharmacists tackling the socioeconomic problem of leftovers in Portugal

In Portugal, oral antibiotics are usually dispensed in a predefined package size at the local community pharmacy. This rigid system can create inefficiencies (e.g. leftovers), since prescription regimens are flexible and sometimes the package does not correspond exactly to the prescribed treatment. To provide a solution to this problem, the Hospital do Divino Espirito Santo de Ponta Delgada (HDES) opened a Public Sales Unit (PSU) with a unit dose dispensing system of pharmaceuticals for its patients. The aim of this study was to characterize and evaluate the unit dose system for oral antibiotics dispensing at the HDES-PSU, and to extrapolate the results at the Portuguese nationwide level. Oral antibiotics dispensing dynamics at the HDES-PSU were examined over a period of 1 year. Dispensed prescriptions were analyzed, and relevant information was collected and entered into a digital database for analysis. To extrapolate results at a nationwide level, a database from Statistics Portugal was used. The results revealed that the 663 registered interventions provided overall savings of 3939 pharmaceutical units, corresponding to €1032.99. The Portuguese nationwide extrapolation indicated that a total of 276,833 pharmaceutical interventions could be registered, corresponding to 1,544,317 pharmaceutical units saved and to €434,085.85 in monetary savings. The present study provides insights into how a unit dose dispensing system can contribute to solving the socioeconomic problems raised by leftovers of oral antibiotics dispensing practices occurring in healthcare systems such as the Portuguese one.

Burden of Liver Cirrhosis in Portugal between 2010 and 2017

Introduction: Liver cirrhosis is a prevalent disease in Portugal. Recent changes in alcohol consumption, as well as the wide use of direct-acting antivirals for hepatitis C since 2015, may be contributing to changes in the national burden of liver cirrhosis in the last few years. Objectives: We aim to characterize the burden of cirrhosis in Portugal between 2010 and 2017. Patients and Methods: We analyzed all hospital admission episodes due to cirrhosis in Portugal Mainland between 2010 and 2017, registered in the national Diagnosis-Related Group database, according to etiology of cirrhosis. We also analyzed data on mortality and potential years of life lost from liver cirrhosis and chronic liver disease, retrieved from Statistics Portugal (National Institute for Statistics). Results: Between 2010 and 2017, a total of 51,438 admissions for liver cirrhosis occurred in Portugal. The annual number of admissions decreased (p = 0.044) during the analyzed period. The most frequent cause of cirrhosis was alcoholic liver disease, present in 78.9% of all admissions (n = 40,595), followed by chronic hepatitis C virus infection, present in 11.3% (n = 5,823). A male predominance was identified in the admissions for every analyzed cause of cirrhosis. Annual admissions for alcoholic cirrhosis remained stable (p = 0.075) during the 8-year period. The same stable tendency was observed in the number of admissions for cirrhosis caused by hepatitis C virus (p = 0.861) and alcohol plus hepatitis C virus infection (p = 0.082), although these admissions for hepatitis C-related cirrhosis increased until 2014–2015 and steadily decreased thereafter. Annual deaths due to liver cirrhosis and chronic liver disease decreased from 1,357 in 2010 to 1,038 in 2017 (p = 0.002). The number of potential years of life lost decreased as well in the period (p = 0.001). Conclusion: The burden of cirrhosis, evaluated by hospital admissions, mortality, and potential years of life lost, decreased in Portugal between 2010 and 2017.

Measuring progress against cancer in the Azores, Portugal: Incidence, survival, and mortality trends and projections to 2025

BackgroundMeasuring progress against cancer is more accurate when trends in incidence, survival, and mortality are interpreted simultaneously. Our study aims to analyze how these key metrics have evolved over time in the Azores, Portugal. MethodsData for incident cases diagnosed in 1997–2016 and followed up through December 31, 2017 were obtained from the Azores Cancer Registry. Data for cancer deaths that occurred in 1991–2016 were obtained from Statistics Portugal. To estimate temporal trends, we applied a joinpoint model to age-adjusted rates. We estimated five-year net survival within the framework of relative survival using the Pohar-Perme estimator and predicted the number of cases and deaths in 2025. ResultsIn men, incidence and mortality decreased for stomach, larynx, and prostate cancer. In women, mortality decreased for breast and cervical cancer. Five-year relative survival improved for several cancers, with the most pronounced improvements for prostate cancer in men and colorectal cancer in women (24.1 and 27.9 percentage point absolute increase, respectively). Conversely, incidence and mortality increased for colorectal cancer in men and lung cancer in women. The incidence and mortality burdens are both expected to increase in 2025. ConclusionOverall, progress against cancer in the Azores has been mixed, and much of the progress has been driven by advances in treatment. Statistics for lung cancer in women and colorectal cancer in men are a call to action for policymakers. Reducing tobacco use and tackling the obesity epidemic are the two public health priorities for cancer control within the region.

Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data

ObjectivesThis study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex...

Relationship between air temperature and mortality in two Portuguese cities

Abstract Background Current global climate changes are significant and the concern with temperature-related mortality have been investigated, especially related to extreme heat. In the current Portuguese scenario of health decentralization to municipalities, knowing the local climate profile associated to other risks allows public policies to be implemented to protect population. Methods The present study is observational and cross-sectional in two Portuguese cities, Odivelas and Torres Vedras. The daily data on average temperature and the number of deaths were analyzed between 2015 to 2018. The data were provided by statistics Portugal and Portuguese Institute of Sea and Atmosphere. For data organization and preliminary analysis, Microsoft Power BI and Phyton software were used. Results A scatter plot of the average day-temperature versus the number of deaths showed that the variables did not present a clear functional form, but there is symmetry on the graph. Preliminary analyzes were performed between these variables which resulted in a Pearsońs coefficient of -0.17 (p-value = 0.000, confidential interval = 95%) for Torres Vedras and -0.21 (p-value = 0.000, confidential interval = 95%) for Odivelas. The negative coefficient means the lower the temperature, greater the number of deaths. However, these results show that the coefficient is weak and there is no correlation with each other. Conclusions The result shows that the average day-temperature and the number of deaths is not correlated and it will be necessary to include other variables in the study. Other data will be assessed, including period and related factors (season and seasonality, for example). The statistical evaluation for the maximum and minimum temperature data for the day will be applied. Gender and age will be available too. In addition, mortality, morbidity, medication consumption and other environmental variables will also be analyzed. Key messages We believe that the results of this study will provide data for the development of public health policies. The decentralization of health to cities is a challenge that needs data support.

No country for old men: gender disparities in Portuguese mortality

Abstract Background Portugal is divided into 25 NUTS 3 (Nomenclature of Territorial Units for Statistics). Mortality tracking is one of the core elements of SDG3 indicators. It can also be used as an essential metric to SDG5 on gender disparities. This study looked into gender disparities in mortality in Portugal. Methods We used data from Statistics Portugal, precisely the standardized rate of potential years of life lost per 100 000 inhabitants to all causes of death using the standard European population by gender. We subdivided by NUTS 3 and we have plotted PYLL for males, females, and the difference between both for the year 2018 using ArcMap 10.7.1. Further descriptive analysis was conducted in R 3.61 and Rstudio 1.2.5033. Results We have found significant gender disparities in mortality. These gender disparities afflicted men the most. In 88% of NUTS3, the PYLL difference of more than 2000 years/100000 when comparing men with women. The higher disparities were in the Azores, Alto Tâmega, and the Douro. Some of the critical specific causes of mortality that lead to this disparity are malignant tumors, mental health problems, alcohol abuse, circulatory system diseases, accidents, and suicides. Conclusions We have found that there are significant disparities in gender mortality targeting men. Although it is higher in some Portuguese regions, the problem is widespread. Further research is needed to address the causes of gender disparity in health outcomes in Portugal. Key messages Huge gap in YPLL between men and women, starting an young adult age. The urgent need for health programs that target men health problems.

Forest fires across Portuguese municipalities: zones of similar incidence, interactions and benchmarks

Every year fires cause several problems and considerable damage to the Portuguese socioeconomic context and to forest resources and activities, despite the significant financial support, from national and European Union budgets, towards prevention. This is an annual scourge that requires multidisciplinary analysis to aid in the design of adjusted firefighting strategies. In this framework, the objective of the study presented here is to investigate if there are Portuguese regions where the incidences of fire, in terms of number of fires and burnt area, are similar, helping toward the creation of firefighting policies in cooperation with neighbouring municipalities. On the other hand, there is a need to understand the interactions of these contexts between the environment and human ecology and finally find municipalities that may be considered as a benchmark for others around them. For this, data from the Statistics Portugal (INE in Several statistics and informations, 2015. https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_base_dados ), for the period 2000–2013, was used and analyzed through descriptive and cross-section techniques and data envelopment analysis (DEA) for the municipalities of Continental Portugal. For the cross-section analysis, the GeoDa (Software. GeoDa Center for Geospatial Analysis and Computation, 2015) software was used considering spatial autocorrelation methodologies and for the DEA the DEAP (DEAP V2.1—a data envelopment analysis (computer) program, 2017. http://www.uq.edu.au/economics/cepa/deap.php ) program. The results show that there is spatial autocorrelation across Portuguese municipalities, in the period considered, for the variables considered, which allows for the definition of “regions of similar incidence” for which similar policies can be designed, namely those promoting cooperation among neighbouring municipalities. In turn, some municipalities may be considered as benchmarks inside zones of similar incidence.

Heart failure in numbers: Estimates for the 21st century in Portugal

Abstract Introduction and Objective Heart failure is a major public health problem that affects a large number of individuals and is associated with high mortality and morbidity. This study aims to estimate the probable scenario for HF prevalence and its consequences in the short-, medium- and long-term in Portugal. Methods This assessment is based on the EPICA (Epidemiology of Heart Failure and Learning) project, which was designed to estimate the prevalence of chronic heart failure in mainland Portugal in 1998. Estimates of heart failure prevalence were performed for individuals aged over 25 years, distributed by age group and gender, based on data from the 2011 Census by Statistics Portugal. Results The expected demographic changes, particularly the marked aging of the population, mean that a large number of Portuguese will likely be affected by this syndrome. Assuming that current clinical practices are maintained, the prevalence of heart failure in mainland Portugal will increase by 30% by 2035 and by 33% by 2060, compared to 2011, resulting in 479 921 and 494 191 affected individuals, respectively. Conclusions In addition to the large number of heart failure patients expected, it is estimated that the hospitalizations and mortality associated with this syndrome will significantly increase its economic impact. Therefore, it is extremely important to raise awareness of this syndrome, as this will favor diagnosis and early referral of patients, facilitating better management of heart failure and helping to decrease the burden it imposes on Portugal.

Insuficiência cardíaca em números: estimativas para o século XXI em Portugal

Introduction and ObjectiveHeart failure is a major public health problem that affects a large number of individuals and is associated with high mortality and morbidity. This study aims to estimate the probable scenario for HF prevalence and its consequences in the short‐, medium‐ and long‐term in Portugal. MethodsThis assessment is based on the EPICA (Epidemiology of Heart Failure and Learning) project, which was designed to estimate the prevalence of chronic heart failure in mainland Portugal in 1998. Estimates of heart failure prevalence were performed for individuals aged over 25 years, distributed by age group and gender, based on data from the 2011 Census by Statistics Portugal. ResultsThe expected demographic changes, particularly the marked aging of the population, mean that a large number of Portuguese will likely be affected by this syndrome. Assuming that current clinical practices are maintained, the prevalence of heart failure in mainland Portugal will increase by 30% by 2035 and by 33% by 2060, compared to 2011, resulting in 479 921 and 494 191 affected individuals, respectively. ConclusionsIn addition to the large number of heart failure patients expected, it is estimated that the hospitalizations and mortality associated with this syndrome will significantly increase its economic impact. Therefore, it is extremely important to raise awareness of this syndrome, as this will favor diagnosis and early referral of patients, facilitating better management of heart failure and helping to decrease the burden it imposes on Portugal.

Prostate cancer incidence and mortality in Portugal: trends, projections and regional differences.

There is a large geographical variability in prostate cancer incidence and mortality trends, mostly because of heterogeneity in control efforts across regions. We aimed to describe the time trends in prostate cancer incidence and mortality in Portugal, overall and by region, and to estimate the number of incident cases and deaths in 2020. The number of cases and incidence rates in 1998-2009 were collected from the Regional Cancer Registries. The number of deaths and mortality rates were obtained from the WHO mortality database (1988-2003 and 2007-2013) and Statistics Portugal (2004-2006; 1991-2013 by region). JoinPoint analyses were used to identify significant changes in trends in age-standardized incidence and mortality rates. Incidence and mortality predictions for 2020 were performed using Poisson regression models and population projections provided by Statistics Portugal. In Portugal, prostate cancer incidence has been increasing since 1998 (1.8%/year), with the exception of the North Region, with a decrease since 2006 (-3.2%/year). An overall mortality decline has been observed since 1997 (-2.2%/year), although there were two patterns of mortality variation at the regional level: one with an inflection point or significant variation in the rates and the other without significant variation. If these trends are maintained, ∼8600 incident cases and 1700 deaths may be expected to occur in Portugal in 2020. Despite the overall increasing incidence and decreasing mortality, there is a large heterogeneity across regions. Future studies should address regional differences in the trends of prostate specific antigen screening and in the effective management of prostate cancer.

How to integrate statistical and geospatial data using administrative data on construction works

The Indicators System of Urban Operations (SIOU) is based on administrative data from the Portuguese municipalities, concerning building permits, completed construction works and its characteristics and includes a set of statistical indicators disseminated by Statistics Portugal as the most importa nt to characterize the construction sector in Portugal. Based on geo-referenced data from 2011 Population and Housing Census, a Register including all the buildings and dwellings was created, corresponding to the stock updated by the Census. This Register aims to be used as the population from which the samples for the household surveys will be selected by Statistics Portugal. Thus, there is a need to permanently update this National Dwellings Register with new constructed buildings and dwellings (and excluding the demolitions). The SIOU was re-designed in order to allow its use for this purpose, namely by including information concerning the geo-referenced data for every building and specific characteristics to identify in a proper way the correct address of new dwellings. The SIOU is a good example of how administrative data is used to integrate statistical and geospatial data, allowing the updating of National Dwellings Register and the production of statistical indicators and specific geospatial data on this statistical area.

Methodology to design a Map of Alert for population and housing censuses: The Portuguese case

The Portuguese Population and Housing Census is carried out every 10 years by Statistics Portugal. In the Census 2011, a new tool was developed to assist the Quality Assurance system in order to make the monitoring of fieldwork operations more efficient and thus diminish the uncertainties that could cause coverage error in the results. This tool, named as Map of Alert, presents a three-level typology of alert that ensures advance knowledge of the potential risk of each freguesia’s failure to meet the quality standards defined for the enumeration process. This article describes the methodological process that guided the development of the Map of Alert and presents the Map itself.

Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013

Introduction and ObjectivesEstimates of the burden of ischemic heart disease (IHD), including geographic differences, should support health policy decisions. We set out to estimate the burden of IHD in mainland Portugal in 2013 by calculating disability-adjusted life years (DALYs) and to compare this burden between five regions. MethodsYears of life lost (YLLs) were calculated by multiplying the number of IHD deaths in 2013 (Statistics Portugal) by the life expectancy at the age at which death occurred. Years lived with disability (YLDs) were computed as the number of cases of acute coronary syndrome, stable angina and ischemic heart failure multiplied by an average disability weight. Crude and age-standardized DALYs (direct method, Standard European Population) were calculated for mainland Portugal and for the Northern, Central, Lisbon, Alentejo and Algarve regions. ResultsIn 2013, 95413 DALYs were lost in mainland Portugal due to IHD. YLLs accounted for 88.3% of the disease burden. Age-standardized DALY rates per 1000 population were higher in men than in women, across the entire country (8.9 in men; 3.4 in women) and within each region, ranging from 7.3 in the Northern and Central regions to 11.8 in the Algarve in men, and from 2.6 in the Northern region to 4.6 in Lisbon in women. ConclusionsNearly 100000 DALYs were lost to IHD in Portugal, mostly through early mortality. This study enables accurate comparisons with other countries and between regions; however, it highlights the need for population-based studies to obtain specific data on morbidity.