title: Estimation of the real population and its impact on the utilisation of healthcare services in Mediterranean resort regions: an ecological study.
abstract: BACKGROUND
  The demographic structure has a significant influence on the use of healthcare services, as does the size of the population denominators. Very few studies have been published on methods for estimating the real population such as tourist resorts. The lack of information about these problems means there is a corresponding lack of information about the behaviour of populational denominators (the floating population or tourist load) and the effect of this on the use of healthcare services. The objectives of the study were: a) To determine the Municipal Solid Waste (MSW) ratio, per person per day, among populations of known size; b) to estimate, by means of this ratio, the real population in an area where tourist numbers are very significant; and c) to determine the impact on the utilisation of hospital emergency healthcare services of the registered population, in comparison to the non-resident population, in two areas where tourist numbers are very significant.
  
  
  METHODS
  An ecological study design was employed. We analysed the Healthcare Districts of the Costa del Sol and the island of Menorca. Both are Spanish territories in the Mediterranean region.
  
  
  RESULTS
  In the two areas analysed, the correlation coefficient between the MSW ratio and admissions to hospital emergency departments exceeded 0.9, with p < 0.001. On the basis of MSW generation ratios, obtained for a control zone and also measured in neighbouring countries, we estimated the real population. For the summer months, when tourist activity is greatest and demand for emergency healthcare at hospitals is highest, this value was found to be double that of the registered population.
  
  
  CONCLUSIONS
  The MSW indicator, which is both ecological and indirect, can be used to estimate the real population in areas where population levels vary significantly during the year. This parameter is of interest in planning and dimensioning the provision of healthcare services.
authors.affiliation: Unidad de Apoyo a la Investigación, Evaluación y Contabilidad (Red IRYSS), Hospital Costa del Sol, Ctra Nacional 340, km 187, 29600 Marbella, Spain. eperea@hcs.es
authors.forename: Emilio
authors.initials: E
authors.lastname: Perea-Milla
authors.forename: Sergi Mari
authors.initials: SM
authors.lastname: Pons
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.forename: Anna
authors.initials: A
authors.lastname: Gallofre
authors.forename: Enrique Navarro
authors.initials: EN
authors.lastname: Jurado
authors.forename: Marco A Navarro
authors.initials: MA
authors.lastname: Ales
authors.forename: Alberto
authors.initials: A
authors.lastname: Jimenez-Puente
authors.forename: Fidel
authors.initials: F
authors.lastname: Fernandez-Nieto
authors.forename: Joan C March
authors.initials: JC
authors.lastname: Cerda
authors.forename: Manuel
authors.initials: M
authors.lastname: Carrasco
authors.forename: Lydia
authors.initials: L
authors.lastname: Martin
authors.forename: Damian Lopez
authors.initials: DL
authors.lastname: Cano
authors.forename: Gonzalo E
authors.initials: GE
authors.lastname: Gutierrez
authors.forename: Rafael Cortes
authors.initials: RC
authors.lastname: Macías
authors.forename: Jose A
authors.initials: JA
authors.lastname: Garcia-Ruiz
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D004463:Ecology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000208:ethnology; D006294:Health Resorts / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D011157:Population Dynamics; D012537:Scandinavian and Nordic Countries / Q000208:ethnology; D012621:Seasons; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D014195:Travel / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000208:ethnology; D014600:Utilization Review; D018505:Waste Management / Q000706:statistics & numerical data*