title: Seasonal variation in orthopedic health services utilization in Switzerland: the impact of winter sport tourism.
abstract: BACKGROUND
  Climate- or holiday-related seasonality in hospital admission rates is well known for many diseases. However, little research has addressed the impact of tourism on seasonality in admission rates. We therefore investigated the influence of tourism on emergency admission rates in Switzerland, where winter and summer leisure sport activities in large mountain regions can generate orthopedic injuries.
  
  
  METHODS
  Using small area analysis, orthopedic hospital service areas (HSAo) were evaluated for seasonality in emergency admission rates. Winter sport areas were defined using guest bed accommodation rate patterns of guest houses and hotels located above 1000 meters altitude that show clear winter and summer peak seasons. Emergency admissions (years 2000-2002, n = 135'460) of local and nonlocal HSAo residents were evaluated. HSAo were grouped according to their area type (regular or winter sport area) and monthly analyses of admission rates were performed.
  
  
  RESULTS
  Of HSAo within the defined winter sport areas 70.8% show a seasonal, summer-winter peak hospital admission rate pattern and only 1 HSAo outside the defined winter sport areas shows such a pattern. Seasonal hospital admission rates in HSAo in winter sport areas can be up to 4 times higher in winter than the intermediate seasons, and they are almost entirely due to admissions of nonlocal residents. These nonlocal residents are in general -and especially in winter- younger than local residents, and nonlocal residents have a shorter length of stay in winter sport than in regular areas. The overall geographic distribution of nonlocal residents admitted for emergencies shows highest rates during the winter as well as the summer in the winter sport areas.
  
  
  CONCLUSIONS
  Small area analysis using orthopedic hospital service areas is a reliable method for the evaluation of seasonality in hospital admission rates. In Switzerland, HSAo defined as winter sport areas show a clear seasonal fluctuation in admission rates of only nonlocal residents, whereas HSAo defined as regular, non-winter sport areas do not show such seasonality. We conclude that leisure sport, and especially ski/snowboard tourism demands great flexibility in hospital beds, staff and resource planning in these areas.
authors.affiliation: Institute for Evaluative Research in Orthopedic Surgery, MEM centre, University of Bern, Stauffacherstrasse, Bern, Switzerland. klazien.matter@memcenter.unibe.ch
authors.forename: Klazien
authors.initials: K
authors.lastname: Matter-Walstra
authors.forename: Marcel
authors.initials: M
authors.lastname: Widmer
authors.forename: André
authors.initials: A
authors.lastname: Busato
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D001642:Bicycling / Q000293:injuries; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005843:Geography; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009051:Mountaineering / Q000293:injuries; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D012111:Residence Characteristics / Q000145:classification; D012621:Seasons; D012865:Skiing / Q000293:injuries; D017062:Small-Area Analysis; D013557:Switzerland / Q000453:epidemiology; D014195:Travel / Q000706:statistics & numerical data