Locally defined dataset containing a full list of patient registrations held within the Trust's EHR system. Details extend to include GP details and patient identifers.

Field Name	Data Type	Description
Statefp	Number	US Census Bureau unique identifier of the state
Countyfp	Number	US Census Bureau unique identifier of the county
Countynm	Text	County name
Tractce	Number	US Census Bureau unique identifier of the census tract
Geoid	Number	US Census Bureau unique identifier of the state + county + census tract
Aland	Number	US Census Bureau defined land area of the census tract
Awater	Number	US Census Bureau defined water area of the census tract
Asqmi	Number	Area calculated in square miles from the Aland
MSSAid	Text	ID of the Medical Service Study Area (MSSA) the census tract belongs to
MSSAnm	Text	Name of the Medical Service Study Area (MSSA) the census tract belongs to
Definition	Text	Type of MSSA, possible values are urban, rural and frontier.
TotalPovPop	Number	US Census Bureau total population for whom poverty status is determined of the census tract, taken from the 2020 ACS 5 YR S1701

Note: Reporting of new COVID-19 Case Surveillance data will be discontinued July 1, 2024, to align with the process of removing SARS-CoV-2 infections (COVID-19 cases) from the list of nationally notifiable diseases. Although these data will continue to be publicly available, the dataset will no longer be updated.

Authorizations to collect certain public health data expired at the end of the U.S. public health emergency declaration on May 11, 2023. The following jurisdictions discontinued COVID-19 case notifications to CDC: Iowa (11/8/21), Kansas (5/12/23), Kentucky (1/1/24), Louisiana (10/31/23), New Hampshire (5/23/23), and Oklahoma (5/2/23). Please note that these jurisdictions will not routinely send new case data after the dates indicated. As of 7/13/23, case notifications from Oregon will only include pediatric cases resulting in death.

This case surveillance public use dataset has 12 elements for all COVID-19 cases shared with CDC and includes demographics, any exposure history, disease severity indicators and outcomes, presence of any underlying medical conditions and risk behaviors, and no geographic data.

CDC has three COVID-19 case surveillance datasets:

• COVID-19 Case Surveillance Public Use Data with Geography: Public use, patient-level dataset with clinical data (including symptoms), demographics, and county and state of residence. (19 data elements)
• COVID-19 Case Surveillance Public Use Data: Public use, patient-level dataset with clinical and symptom data and demographics, with no geographic data. (12 data elements)
• COVID-19 Case Surveillance Restricted Access Detailed Data: Restricted access, patient-level dataset with clinical and symptom data, demographics, and state and county of residence. Access requires a registration process and a data use agreement. (33 data elements)

The following apply to all three datasets:

• Data elements can be found on the COVID-19 case report form located at www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf.
• Data are considered provisional by CDC and are subject to change until the data are reconciled and verified with the state and territorial data providers.
• Some data cells are suppressed to protect individual privacy.
• The datasets will include all cases with the earliest date available in each record (date received by CDC or date related to illness/specimen collection) at least 14 days prior to the creation of the current datasets. This 14-day lag allows case reporting to be stabilized and ensures that time-dependent outcome data are accurately captured.
• Datasets are updated monthly.
• Datasets are created using CDC’s Policy on Public Health Research and Nonresearch Data Management and Access and include protections designed to protect individual privacy.
• For more information about data collection and reporting, please see https://www.cdc.gov/coronavirus/2019-ncov/covid-data/about-us-cases-deaths.html.
• For more information about the COVID-19 case surveillance data, please see https://www.cdc.gov/coronavirus/2019-ncov/covid-data/faq-surveillance.html
  

Overview

The COVID-19 case surveillance database includes individual-level data reported to U.S. states and autonomous reporting entities, including New York City and the District of Columbia (D.C.), as well as U.S. territories and affiliates. On April 5, 2020, COVID-19 was added to the Nationally Notifiable Condition List and classified as “immediately notifiable, urgent (within 24 hours)” by a Council of State and Territorial Epidemiologists (CSTE) Interim Position Statement (Interim-20-ID-01). CSTE updated the position statement on August 5, 2020, to clarify the interpretation of antigen detection tests and serologic test results within the case classification (Interim-20-ID-02). The statement also recommended that all states and territories enact laws to make COVID-19 reportable in their jurisdiction, and that jurisdictions conducting surveillance should submit case notifications to CDC. COVID-19 case surveillance data are collected by jurisdictions and reported voluntarily to CDC.

For more information: NNDSS Supports the COVID-19 Response | CDC.

The deidentified data in the “COVID-19 Case Surveillance Public Use Data” include demographic characteristics, any exposure history, disease severity indicators and outcomes, clinical data, laboratory diagnostic test results, and presence of any underlying medical conditions and risk behaviors. All data elements can be found on the COVID-19 case report form located at www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf.

COVID-19 Case Reports

COVID-19 case reports have been routinely submitted using nationally standardized case reporting forms. On April 5, 2020, CSTE released an Interim Position Statement with national surveillance case definitions for COVID-19 included. Current versions of these case definitions are available here: https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2021/.

All cases reported on or after were requested to be shared by public health departments to CDC using the standardized case definitions for laboratory-confirmed or probable cases. On May 5, 2020, the standardized case reporting form was revised. Case reporting using this new form is ongoing among U.S. states and territories.

Data are Considered Provisional

• The COVID-19 case surveillance data are dynamic; case reports can be modified at any time by the jurisdictions sharing COVID-19 data with CDC. CDC may update prior cases shared with CDC based on any updated information from jurisdictions. For instance, as new information is gathered about previously reported cases, health departments provide updated data to CDC. As more information and data become available, analyses might find changes in surveillance data and trends during a previously reported time window. Data may also be shared late with CDC due to the volume of COVID-19 cases.
• Annual finalized data: To create the final NNDSS data used in the annual tables, CDC works carefully with the reporting jurisdictions to reconcile the data received during the year until each state or territorial epidemiologist confirms that the data from their area are correct.
• Access Addressing Gaps in Public Health Reporting of Race and Ethnicity for COVID-19, a report from the Council of State and Territorial Epidemiologists, to better understand the challenges in completing race and ethnicity data for COVID-19 and recommendations for improvement.

Data Limitations

To learn more about the limitations in using case surveillance data, visit FAQ: COVID-19 Data and Surveillance.

Data Quality Assurance Procedures

CDC’s Case Surveillance Section routinely performs data quality assurance procedures (i.e., ongoing corrections and logic checks to address data errors). To date, the following data cleaning steps have been implemented:

• Questions that have been left unanswered (blank) on the case report form are reclassified to a Missing value, if applicable to the question. For example, in the question “Was the individual hospitalized?” where the possible answer choices include “Yes,” “No,” or “Unknown,” the blank value is recoded to Missing because the case report form did not include a response to the question.
• Logic checks are performed for date data. If an illogical date has been provided, CDC reviews the data with the reporting jurisdiction. For example, if a symptom onset date in the future is reported to CDC, this value is set to null until the reporting jurisdiction updates the date appropriately.
• Additional data quality processing to recode free text data is ongoing. Data on symptoms, race and ethnicity, and healthcare worker status have been prioritized.

Data Suppression

To prevent release of data that could be used to identify people, data cells are suppressed for low frequency (<5) records and indirect identifiers (e.g., date of first positive specimen). Suppression includes rare combinations of demographic characteristics (sex, age group, race/ethnicity). Suppressed values are re-coded to the NA answer option; records with data suppression are never removed.

For questions, please contact Ask SRRG (eocevent394@cdc.gov).

Additional COVID-19 Data

COVID-19 data are available to the public as summary or aggregate count files, including total counts of cases and deaths by state and by county. These

Medical Service Study Areas (MSSAs)As defined by California's Office of Statewide Health Planning and Development (OSHPD) in 2013, "MSSAs are sub-city and sub-county geographical units used to organize and display population, demographic and physician data" (Source). Each census tract in CA is assigned to a given MSSA. The most recent MSSA dataset (2014) was used. Spatial data are available via OSHPD at the California Open Data Portal. This information may be useful in studying health equity.Definitions:Race/Ethnicity: Race/ethnicity is categorized as: All races/ethnicities, Non-Hispanic (NH) White, NH Black, Asian/Pacific Islander, or Hispanic. "All races" includes all of the above, as well as other and unknown race/ethnicity and American Indian/Alaska Native. The latter two groups are not reported separately due to small numbers for many cancer sites.Racial/Ethnic Composition: Distribution of residents' race/ethnicity (e.g., % Hispanic, % non-Hispanic White, % non-Hispanic Black, % non-Hispanic Asian/Pacific Islander). (Source: US Census, 2010.)Rural: Percent of residents who reside in blocks that are designated as rural. (Source: US Census, 2010.)Foreign Born: Percent of residents who were born outside the United States. (Source: American Community Survey, 2008-2012.)Socioeconomic Status (Neighborhood Level): A composite measure of seven indicator variables created by principal component analysis; indicators include: education, blue-collar job, unemployment, household income, poverty, rent, and house value. Quintiles based on state distribution, with quintile 1 being the lowest SES and 5 being the highest. (Source: American Community Survey, 2008-2012.)Spatial extent: CaliforniaSpatial Unit: MSSACreated: n/aUpdated: n/aSource: California Health MapsContact Email: gbacr@ucsf.eduSource Link: https://www.californiahealthmaps.org/?areatype=mssa&address=&sex=Both&site=AllSite&race=&year=05yr&overlays=none&choropleth=Obesity

After May 3, 2024, this dataset and webpage will no longer be updated because hospitals are no longer required to report data on COVID-19 hospital admissions, and hospital capacity and occupancy data, to HHS through CDC’s National Healthcare Safety Network. Data voluntarily reported to NHSN after May 1, 2024, will be available starting May 10, 2024, at COVID Data Tracker Hospitalizations.

The following dataset provides facility-level data for hospital utilization aggregated on a weekly basis (Sunday to Saturday). These are derived from reports with facility-level granularity across two main sources: (1) HHS TeleTracking, and (2) reporting provided directly to HHS Protect by state/territorial health departments on behalf of their healthcare facilities.

The hospital population includes all hospitals registered with Centers for Medicare & Medicaid Services (CMS) as of June 1, 2020. It includes non-CMS hospitals that have reported since July 15, 2020. It does not include psychiatric, rehabilitation, Indian Health Service (IHS) facilities, U.S. Department of Veterans Affairs (VA) facilities, Defense Health Agency (DHA) facilities, and religious non-medical facilities.

For a given entry, the term “collection_week” signifies the start of the period that is aggregated. For example, a “collection_week” of 2020-11-15 means the average/sum/coverage of the elements captured from that given facility starting and including Sunday, November 15, 2020, and ending and including reports for Saturday, November 21, 2020.

Reported elements include an append of either “_coverage”, “_sum”, or “_avg”.

• A “_coverage” append denotes how many times the facility reported that element during that collection week.
• A “_sum” append denotes the sum of the reports provided for that facility for that element during that collection week.
• A “_avg” append is the average of the reports provided for that facility for that element during that collection week.

The file will be updated weekly. No statistical analysis is applied to impute non-response. For averages, calculations are based on the number of values collected for a given hospital in that collection week. Suppression is applied to the file for sums and averages less than four (4). In these cases, the field will be replaced with “-999,999”.

A story page was created to display both corrected and raw datasets and can be accessed at this link: https://healthdata.gov/stories/s/nhgk-5gpv

This data is preliminary and subject to change as more data become available. Data is available starting on July 31, 2020.

Sometimes, reports for a given facility will be provided to both HHS TeleTracking and HHS Protect. When this occurs, to ensure that there are not duplicate reports, deduplication is applied according to prioritization rules within HHS Protect.

For influenza fields listed in the file, the current HHS guidance marks these fields as optional. As a result, coverage of these elements are varied.

For recent updates to the dataset, scroll to the bottom of the dataset description.

On May 3, 2021, the following fields have been added to this data set.

• hhs_ids
• previous_day_admission_adult_covid_confirmed_7_day_coverage
• previous_day_admission_pediatric_covid_confirmed_7_day_coverage
• previous_day_admission_adult_covid_suspected_7_day_coverage
• previous_day_admission_pediatric_covid_suspected_7_day_coverage
• previous_week_personnel_covid_vaccinated_doses_administered_7_day_sum
• total_personnel_covid_vaccinated_doses_none_7_day_sum
• total_personnel_covid_vaccinated_doses_one_7_day_sum
• total_personnel_covid_vaccinated_doses_all_7_day_sum
• previous_week_patients_covid_vaccinated_doses_one_7_day_sum
• previous_week_patients_covid_vaccinated_doses_all_7_day_sum

On May 8, 2021, this data set has been converted to a corrected data set. The corrections applied to this data set are to smooth out data anomalies caused by keyed in data errors. To help determine which records have had corrections made to it. An additional Boolean field called is_corrected has been added.

On May 13, 2021 Changed vaccination fields from sum to max or min fields. This reflects the maximum or minimum number reported for that metric in a given week.

On June 7, 2021 Changed vaccination fields from max or min fields to Wednesday reported only. This reflects that the number reported for that metric is only reported on Wednesdays in a given week.

On September 20, 2021, the following has been updated: The use of analytic dataset as a source.

On January 19, 2022, the following fields have been added to this dataset:

• inpatient_beds_used_covid_7_day_avg
• inpatient_beds_used_covid_7_day_sum
• inpatient_beds_used_covid_7_day_coverage

On April 28, 2022, the following pediatric fields have been added to this dataset:

• all_pediatric_inpatient_bed_occupied_7_day_avg
• all_pediatric_inpatient_bed_occupied_7_day_coverage
• all_pediatric_inpatient_bed_occupied_7_day_sum
• all_pediatric_inpatient_beds_7_day_avg
• all_pediatric_inpatient_beds_7_day_coverage
• all_pediatric_inpatient_beds_7_day_sum
• previous_day_admission_pediatric_covid_confirmed_0_4_7_day_sum
• previous_day_admission_pediatric_covid_confirmed_12_17_7_day_sum
• previous_day_admission_pediatric_covid_confirmed_5_11_7_day_sum
• previous_day_admission_pediatric_covid_confirmed_unknown_7_day_sum
• staffed_icu_pediatric_patients_confirmed_covid_7_day_avg
• staffed_icu_pediatric_patients_confirmed_covid_7_day_coverage
• staffed_icu_pediatric_patients_confirmed_covid_7_day_sum
• staffed_pediatric_icu_bed_occupancy_7_day_avg
• staffed_pediatric_icu_bed_occupancy_7_day_coverage
• staffed_pediatric_icu_bed_occupancy_7_day_sum
• total_staffed_pediatric_icu_beds_7_day_avg
• total_staffed_pediatric_icu_beds_7_day_coverage
• total_staffed_pediatric_icu_beds_7_day_sum

On October 24, 2022, the data includes more analytical calculations in efforts to provide a cleaner dataset. For a raw version of this dataset, please follow this link: https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/uqq2-txqb

Due to changes in reporting requirements, after June 19, 2023, a collection week is defined as starting on a Sunday and ending on the next Saturday.

The NIHR is one of the main funders of public health research in the UK. Public health research falls within the remit of a range of NIHR Research Programmes, NIHR Centres of Excellence and Facilities, plus the NIHR Academy. NIHR awards from all NIHR Research Programmes and the NIHR Academy that were funded between January 2006 and the present extraction date are eligible for inclusion in this dataset. An agreed inclusion/exclusion criteria is used to categorise awards as public health awards (see below). Following inclusion in the dataset, public health awards are second level coded to one of the four Public Health Outcomes Framework domains. These domains are: (1) wider determinants (2) health improvement (3) health protection (4) healthcare and premature mortality.More information on the Public Health Outcomes Framework domains can be found here.This dataset is updated quarterly to include new NIHR awards categorised as public health awards. Please note that for those Public Health Research Programme projects showing an Award Budget of £0.00, the project is undertaken by an on-call team for example, PHIRST, Public Health Review Team, or Knowledge Mobilisation Team, as part of an ongoing programme of work.Inclusion criteriaThe NIHR Public Health Overview project team worked with colleagues across NIHR public health research to define the inclusion criteria for NIHR public health research awards. NIHR awards are categorised as public health awards if they are determined to be ‘investigations of interventions in, or studies of, populations that are anticipated to have an effect on health or on health inequity at a population level.’ This definition of public health is intentionally broad to capture the wide range of NIHR public health awards across prevention, health improvement, health protection, and healthcare services (both within and outside of NHS settings). This dataset does not reflect the NIHR’s total investment in public health research. The intention is to showcase a subset of the wider NIHR public health portfolio. This dataset includes NIHR awards categorised as public health awards from NIHR Research Programmes and the NIHR Academy. This dataset does not currently include public health awards or projects funded by any of the three NIHR Research Schools or any of the NIHR Centres of Excellence and Facilities. Therefore, awards from the NIHR Schools for Public Health, Primary Care and Social Care, NIHR Public Health Policy Research Unit and the NIHR Health Protection Research Units do not feature in this curated portfolio.DisclaimersUsers of this dataset should acknowledge the broad definition of public health that has been used to develop the inclusion criteria for this dataset. This caveat applies to all data within the dataset irrespective of the funding NIHR Research Programme or NIHR Academy award.Please note that this dataset is currently subject to a limited data quality review. We are working to improve our data collection methodologies. Please also note that some awards may also appear in other NIHR curated datasets. Further informationFurther information on the individual awards shown in the dataset can be found on the NIHR’s Funding & Awards website here. Further information on individual NIHR Research Programme’s decision making processes for funding health and social care research can be found here.Further information on NIHR’s investment in public health research can be found as follows: NIHR School for Public Health here. NIHR Public Health Policy Research Unit here. NIHR Health Protection Research Units here. NIHR Public Health Research Programme Health Determinants Research Collaborations (HDRC) here. NIHR Public Health Research Programme Public Health Intervention Responsive Studies Teams (PHIRST) here.

Part of a set of two collections for patient-level costing, which provide a consistent approach to reporting cost information at patient level.

This is the current Medical Service Study Area. California Medical Service Study Areas are created by the California Department of Health Care Access and Information (HCAI).Check the Data Dictionary for field descriptions.Search for the Medical Service Study Area data on the CHHS Open Data Portal.Checkout the California Healthcare Atlas for more Medical Service Study Area information.This is an update to the MSSA geometries and demographics to reflect the new 2020 Census tract data. The Medical Service Study Area (MSSA) polygon layer represents the best fit mapping of all new 2020 California census tract boundaries to the original 2010 census tract boundaries used in the construction of the original 2010 MSSA file. Each of the state's new 9,129 census tracts was assigned to one of the previously established medical service study areas (excluding tracts with no land area), as identified in this data layer. The MSSA Census tract data is aggregated by HCAI, to create this MSSA data layer. This represents the final re-mapping of 2020 Census tracts to the original 2010 MSSA geometries. The 2010 MSSA were based on U.S. Census 2010 data and public meetings held throughout California.Source of update: American Community Survey 5-year 2006-2010 data for poverty. For source tables refer to InfoUSA update procedural documentation. The 2010 MSSA Detail layer was developed to update fields affected by population change. The American Community Survey 5-year 2006-2010 population data pertaining to total, in households, race, ethnicity, age, and poverty was used in the update. The 2010 MSSA Census Tract Detail map layer was developed to support geographic information systems (GIS) applications, representing 2010 census tract geography that is the foundation of 2010 medical service study area (MSSA) boundaries. ***This version is the finalized MSSA reconfiguration boundaries based on the US Census Bureau 2010 Census. In 1976 Garamendi Rural Health Services Act, required the development of a geographic framework for determining which parts of the state were rural and which were urban, and for determining which parts of counties and cities had adequate health care resources and which were "medically underserved". Thus, sub-city and sub-county geographic units called "medical service study areas [MSSAs]" were developed, using combinations of census-defined geographic units, established following General Rules promulgated by a statutory commission. After each subsequent census the MSSAs were revised. In the scheduled revisions that followed the 1990 census, community meetings of stakeholders (including county officials, and representatives of hospitals and community health centers) were held in larger metropolitan areas. The meetings were designed to develop consensus as how to draw the sub-city units so as to best display health care disparities. The importance of involving stakeholders was heightened in 1992 when the United States Department of Health and Human Services' Health and Resources Administration entered a formal agreement to recognize the state-determined MSSAs as "rational service areas" for federal recognition of "health professional shortage areas" and "medically underserved areas". After the 2000 census, two innovations transformed the process, and set the stage for GIS to emerge as a major factor in health care resource planning in California. First, the Office of Statewide Health Planning and Development [OSHPD], which organizes the community stakeholder meetings and provides the staff to administer the MSSAs, entered into an Enterprise GIS contract. Second, OSHPD authorized at least one community meeting to be held in each of the 58 counties, a significant number of which were wholly rural or frontier counties. For populous Los Angeles County, 11 community meetings were held. As a result, health resource data in California are collected and organized by 541 geographic units. The boundaries of these units were established by community healthcare experts, with the objective of maximizing their usefulness for needs assessment purposes. The most dramatic consequence was introducing a data simultaneously displayed in a GIS format. A two-person team, incorporating healthcare policy and GIS expertise, conducted the series of meetings, and supervised the development of the 2000-census configuration of the MSSAs.MSSA Configuration Guidelines (General Rules):- Each MSSA is composed of one or more complete census tracts.- As a general rule, MSSAs are deemed to be "rational service areas [RSAs]" for purposes of designating health professional shortage areas [HPSAs], medically underserved areas [MUAs] or medically underserved populations [MUPs].- MSSAs will not cross county lines.- To the extent practicable, all census-defined places within the MSSA are within 30 minutes travel time to the largest population center within the MSSA, except in those circumstances where meeting this criterion would require splitting a census tract.- To the extent practicable, areas that, standing alone, would meet both the definition of an MSSA and a Rural MSSA, should not be a part of an Urban MSSA.- Any Urban MSSA whose population exceeds 200,000 shall be divided into two or more Urban MSSA Subdivisions.- Urban MSSA Subdivisions should be within a population range of 75,000 to 125,000, but may not be smaller than five square miles in area. If removing any census tract on the perimeter of the Urban MSSA Subdivision would cause the area to fall below five square miles in area, then the population of the Urban MSSA may exceed 125,000. - To the extent practicable, Urban MSSA Subdivisions should reflect recognized community and neighborhood boundaries and take into account such demographic information as income level and ethnicity. Rural Definitions: A rural MSSA is an MSSA adopted by the Commission, which has a population density of less than 250 persons per square mile, and which has no census defined place within the area with a population in excess of 50,000. Only the population that is located within the MSSA is counted in determining the population of the census defined place. A frontier MSSA is a rural MSSA adopted by the Commission which has a population density of less than 11 persons per square mile. Any MSSA which is not a rural or frontier MSSA is an urban MSSA. Last updated December 6th 2024.

The Overview of Health Disparities analysis is a component of the Healthy People 2020 (HP2020) Final Review. The analysis included 611 objectives in HP2020. See Technical Notes for the Healthy People 2020 Overview of Health Disparities (https://www.cdc.gov/nchs/healthy_people/hp2020/health-disparities.htm) for additional information and criteria for objectives, data years, and population characteristics included in the analysis and statistical formulas and definitions for the disparities measures. This file contains estimates and standard errors for the baseline and final years for individual population groups used in the Overview of Health Disparities analysis. The number and definitions of population groups varied across the HP2020 objectives and data sources used. These population groups are shown in the disparities file as originally reported by the data source, rather than the harmonized categories that were used for the HP2020 Progress by Population Group analysis (https://www.cdc.gov/nchs/healthy_people/hp2020/population-groups.htm). Additionally, for any given objective, the baseline and final years used for the disparities analysis do not necessarily correspond to the baseline and final years used to evaluate progress toward target attainment in the HP2020 Final Review Progress Table (https://www.cdc.gov/nchs/healthy_people/hp2020/progress-tables.htm) and Progress by Population Group analysis (https://www.cdc.gov/nchs/healthy_people/hp2020/population-groups.htm). These distinctions should be considered when merging the downloadable Progress Table or Progress by Population Group data files with the Overview of Health Disparities data files, or when integrative analyses that incorporate both disparities and progress data are conducted. Data for additional years during the HP2020 tracking period that are not included in the Overview of Health Disparities are available on the HP2020 website (https://www.healthypeople.gov/2020/).

Analysis of ‘COVID-19 Cases by Population Characteristics Over Time’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/a3291d85-0076-43c5-a59c-df49480cdc6d on 13 February 2022.

--- Dataset description provided by original source is as follows ---

Note: On January 22, 2022, system updates to improve the timeliness and accuracy of San Francisco COVID-19 cases and deaths data were implemented. You might see some fluctuations in historic data as a result of this change. Due to the changes, starting on January 22, 2022, the number of new cases reported daily will be higher than under the old system as cases that would have taken longer to process will be reported earlier.

A. SUMMARY This dataset shows San Francisco COVID-19 cases by population characteristics and by specimen collection date. Cases are included on the date the positive test was collected.

Population characteristics are subgroups, or demographic cross-sections, like age, race, or gender. The City tracks how cases have been distributed among different subgroups. This information can reveal trends and disparities among groups.

Data is lagged by five days, meaning the most recent specimen collection date included is 5 days prior to today. Tests take time to process and report, so more recent data is less reliable.

B. HOW THE DATASET IS CREATED Data on the population characteristics of COVID-19 cases and deaths are from: * Case interviews * Laboratories * Medical providers

These multiple streams of data are merged, deduplicated, and undergo data verification processes. This data may not be immediately available for recently reported cases because of the time needed to process tests and validate cases. Daily case totals on previous days may increase or decrease. Learn more.

Data are continually updated to maximize completeness of information and reporting on San Francisco residents with COVID-19.

Data notes on each population characteristic type is listed below.

Race/ethnicity * We include all race/ethnicity categories that are collected for COVID-19 cases. * The population estimates for the "Other" or “Multi-racial” groups should be considered with caution. The Census definition is likely not exactly aligned with how the City collects this data. For that reason, we do not recommend calculating population rates for these groups.

Sexual orientation * Sexual orientation data is collected from individuals who are 18 years old or older. These individuals can choose whether to provide this information during case interviews. Learn more about our data collection guidelines. * The City began asking for this information on April 28, 2020.

Gender * The City collects information on gender identity using these guidelines.

Comorbidities * Underlying conditions are reported when a person has one or more underlying health conditions at the time of diagnosis or death.

Transmission type * Information on transmission of COVID-19 is based on case interviews with individuals who have a confirmed positive test. Individuals are asked if they have been in close contact with a known COVID-19 case. If they answer yes, transmission category is recorded as contact with a known case. If they report no contact with a known case, transmission category is recorded as community transmission. If the case is not interviewed or was not asked the question, they are counted as unknown.

Homelessness Persons are identified as homeless based on several data sources: * self-reported living situation
* the location at the time of testing * Department of Public Health homelessness and health databases * Residents in Single-Room Occupancy hotels are not included in these figures.
These methods serve as an estimate of persons experiencing homelessness. They may not meet other homelessness definitions.

Skilled Nursing Facility (SNF) occupancy * A Skilled Nursing

--- Original source retains full ownership of the source dataset ---

As of July 2nd, 2024 the COVID-19 Deaths by Population Characteristics Over Time dataset has been retired. This dataset is archived and will no longer update. We will be publishing a cumulative deaths by population characteristics dataset that will update moving forward.

A. SUMMARY This dataset shows San Francisco COVID-19 deaths by population characteristics and by date. This data may not be immediately available for recently reported deaths. Data updates as more information becomes available. Because of this, death totals for previous days may increase or decrease. More recent data is less reliable.

Population characteristics are subgroups, or demographic cross-sections, like age, race, or gender. The City tracks how deaths have been distributed among different subgroups. This information can reveal trends and disparities among groups.

B. HOW THE DATASET IS CREATED As of January 1, 2023, COVID-19 deaths are defined as persons who had COVID-19 listed as a cause of death or a significant condition contributing to their death on their death certificate. This definition is in alignment with the California Department of Public Health and the national https://preparedness.cste.org/wp-content/uploads/2022/12/CSTE-Revised-Classification-of-COVID-19-associated-Deaths.Final_.11.22.22.pdf">Council of State and Territorial Epidemiologists. Death certificates are maintained by the California Department of Public Health.

Data on the population characteristics of COVID-19 deaths are from: *Case reports *Medical records *Electronic lab reports *Death certificates

Data are continually updated to maximize completeness of information and reporting on San Francisco COVID-19 deaths.

To protect resident privacy, we summarize COVID-19 data by only one characteristic at a time. Data are not shown until cumulative citywide deaths reach five or more.

Data notes on each population characteristic type is listed below.

Race/ethnicity * We include all race/ethnicity categories that are collected for COVID-19 cases.

Gender * The City collects information on gender identity using these guidelines.

C. UPDATE PROCESS Updates automatically at 06:30 and 07:30 AM Pacific Time on Wednesday each week.

Dataset will not update on the business day following any federal holiday.

D. HOW TO USE THIS DATASET Population estimates are only available for age groups and race/ethnicity categories. San Francisco population estimates for race/ethnicity and age groups can be found in a view based on the San Francisco Population and Demographic Census dataset. These population estimates are from the 2016-2020 5-year American Community Survey (ACS).

This dataset includes many different types of characteristics. Filter the “Characteristic Type” column to explore a topic area. Then, the “Characteristic Group” column shows each group or category within that topic area and the number of deaths on each date.

New deaths are the count of deaths within that characteristic group on that specific date. Cumulative deaths are the running total of all San Francisco COVID-19 deaths in that characteristic group up to the date listed.

This data may not be immediately available for more recent deaths. Data updates as more information becomes available.

To explore data on the total number of deaths, use the COVID-19 Deaths Over Time dataset.

E. CHANGE LOG

• 9/11/2023 - on this date, we began using an updated definition of a COVID-19 death to align with the California Department o

A. SUMMARY This archived dataset includes data for population characteristics that are no longer being reported publicly. The date on which each population characteristic type was archived can be found in the field “data_loaded_at”.

B. HOW THE DATASET IS CREATED Data on the population characteristics of COVID-19 cases are from:  * Case interviews  * Laboratories  * Medical providers    These multiple streams of data are merged, deduplicated, and undergo data verification processes.  

Race/ethnicity * We include all race/ethnicity categories that are collected for COVID-19 cases. * The population estimates for the "Other" or “Multi-racial” groups should be considered with caution. The Census definition is likely not exactly aligned with how the City collects this data. For that reason, we do not recommend calculating population rates for these groups.

Gender * The City collects information on gender identity using these guidelines.

Skilled Nursing Facility (SNF) occupancy * A Skilled Nursing Facility (SNF) is a type of long-term care facility that provides care to individuals, generally in their 60s and older, who need functional assistance in their daily lives.  * This dataset includes data for COVID-19 cases reported in Skilled Nursing Facilities (SNFs) through 12/31/2022, archived on 1/5/2023. These data were identified where “Characteristic_Type” = ‘Skilled Nursing Facility Occupancy’.

Sexual orientation * The City began asking adults 18 years old or older for their sexual orientation identification during case interviews as of April 28, 2020. Sexual orientation data prior to this date is unavailable. * The City doesn’t collect or report information about sexual orientation for persons under 12 years of age. * Case investigation interviews transitioned to the California Department of Public Health, Virtual Assistant information gathering beginning December 2021. The Virtual Assistant is only sent to adults who are 18+ years old. https://www.sfdph.org/dph/files/PoliciesProcedures/COM9_SexualOrientationGuidelines.pdf">Learn more about our data collection guidelines pertaining to sexual orientation.

Comorbidities * Underlying conditions are reported when a person has one or more underlying health conditions at the time of diagnosis or death.

Homelessness Persons are identified as homeless based on several data sources: * self-reported living situation * the location at the time of testing * Department of Public Health homelessness and health databases * Residents in Single-Room Occupancy hotels are not included in these figures. These methods serve as an estimate of persons experiencing homelessness. They may not meet other homelessness definitions.

Single Room Occupancy (SRO) tenancy * SRO buildings are defined by the San Francisco Housing Code as having six or more "residential guest rooms" which may be attached to shared bathrooms, kitchens, and living spaces. * The details of a person's living arrangements are verified during case interviews.

Transmission Type * Information on transmission of COVID-19 is based on case interviews with individuals who have a confirmed positive test. Individuals are asked if they have been in close contact with a known COVID-19 case. If they answer yes, transmission category is recorded as contact with a known case. If they report no contact with a known case, transmission category is recorded as community transmission. If the case is not interviewed or was not asked the question, they are counted as unknown.

C. UPDATE PROCESS This dataset has been archived and will no longer update as of 9/11/2023.

D. HOW TO USE THIS DATASET Population estimates are only available for age groups and race/ethnicity categories. San Francisco po

The AIDS Public Information Data Set (APIDS) for years 1981-2002 on CDC WONDER online database contains counts of AIDS (Acquired Immune Deficiency Syndrome) cases reported by state and local health departments, by demographics; location (region and selected metropolitan areas); case-definition; month/year and quarter-year of diagnosis, report, and death (if applicable); and HIV exposure group (risk factors for AIDS). Data are produced by the US Department of Health and Human Services (US DHHS), Public Health Service (PHS), Centers for Disease Control and Prevention (CDC), National Center for HIV, STD and TB Prevention (NCHSTP), Division of HIV/AIDS Prevention (DHP).

A. SUMMARY This dataset shows San Francisco COVID-19 deaths by population characteristics. This data may not be immediately available for recently reported deaths. Data updates as more information becomes available. Because of this, death totals may increase or decrease. Population characteristics are subgroups, or demographic cross-sections, like age, race, or gender. The City tracks how deaths have been distributed among different subgroups. This information can reveal trends and disparities among groups. B. HOW THE DATASET IS CREATED As of January 1, 2023, COVID-19 deaths are defined as persons who had COVID-19 listed as a cause of death or a significant condition contributing to their death on their death certificate. This definition is in alignment with the California Department of Public Health and the national Council of State and Territorial Epidemiologists. Death certificates are maintained by the California Department of Public Health. Data on the population characteristics of COVID-19 deaths are from: Case reports Medical records Electronic lab reports Death certificates Data are continually updated to maximize completeness of information and reporting on San Francisco COVID-19 deaths. To protect resident privacy, we summarize COVID-19 data by only one population characteristic at a time. Data are not shown until cumulative citywide deaths reach five or more. Data notes on select population characteristic types are listed below. Race/ethnicity * We include all race/ethnicity categories that are collected for COVID-19 cases. Gender * The City collects information on gender identity using these guidelines. C. UPDATE PROCESS Updates automatically at 06:30 and 07:30 AM Pacific Time on Wednesday each week. Dataset will not update on the business day following any federal holiday. D. HOW TO USE THIS DATASET Population estimates are only available for age groups and race/ethnicity categories. San Francisco population estimates for race/ethnicity and age groups can be found in a dataset based on the San Francisco Population and Demographic Census dataset.These population estimates are from the 2018-2022 5-year American Community Survey (ACS). This dataset includes several characteristic types. Filter the “Characteristic Type” column to explore a topic area. Then, the “Characteristic Group” column shows each group or category within that topic area and the number of cumulative deaths. Cumulative deaths are the running total of all San Francisco COVID-19 deaths in that characteristic group up to the date listed. To explore data on the total number of deaths, use the COVID-19 Deaths Over Time dataset. E. CHANGE LOG

The main goals of the National Post-acute and Long-term Care Study (NPALS) are to: (1) Estimate the supply of paid, regulated long-term care services providers; (2) Estimate key policy-relevant characteristics and practices of these providers; (3) Estimate the number of long-term care services users; (4) Estimate key policy-relevant characteristics of long-term care services users; (5) Produce national and state estimates where feasible within confidentiality and reliability standards; (6) Compare across provider sectors; and (7) Monitor trends over time.

NPALS used a two-stage probability-based sample design. In the first stage, a stratified random sample of providers were selected among adult day service centers (ADSCs); in the second stage, current services users (participants in ADSCs) were randomly selected.

The provider questionnaire included survey items on provider characteristics such as ownership, size, services offered, selected practices, and staffing; questions about aggregate user characteristics (age and race) were included. The services user datasets include user demographics, health conditions, limitations with activities of daily living, number of prescription medications, adverse events, and services used. This is the services user or participant level data file.

The PATH Study was launched in 2011 to inform the Food and Drug Administration's regulatory activities under the Family Smoking Prevention and Tobacco Control Act (TCA). The PATH Study is a collaboration between the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), and the Center for Tobacco Products (CTP), Food and Drug Administration (FDA). The study sampled over 150,000 mailing addresses across the United States to create a national sample of people who use or do not use tobacco. 45,971 adults and youth constitute the first (baseline) wave, Wave 1, of data collected by this longitudinal cohort study. These 45,971 adults and youth along with 7,207 "shadow youth" (youth ages 9 to 11 sampled at Wave 1) make up the 53,178 participants that constitute the Wave 1 Cohort. Respondents are asked to complete an interview at each follow-up wave. Youth who turn 18 by the current wave of data collection are considered "aged-up adults" and are invited to complete the Adult Interview. Additionally, "shadow youth" are considered "aged-up youth" upon turning 12 years old, when they are asked to complete an interview after parental consent. At Wave 4, a probability sample of 14,098 adults, youth, and shadow youth ages 10 to 11 was selected from the civilian, noninstitutionalized population (CNP) at the time of Wave 4. This sample was recruited from residential addresses not selected for Wave 1 in the same sampled Primary Sampling Unit (PSU)s and segments using similar within-household sampling procedures. This "replenishment sample" was combined for estimation and analysis purposes with Wave 4 adult and youth respondents from the Wave 1 Cohort who were in the CNP at the time of Wave 4. This combined set of Wave 4 participants, 52,731 participants in total, forms the Wave 4 Cohort. At Wave 7, a probability sample of 14,863 adults, youth, and shadow youth ages 9 to 11 was selected from the CNP at the time of Wave 7. This sample was recruited from residential addresses not selected for Wave 1 or Wave 4 in the same sampled PSUs and segments using similar within-household sampling procedures. This "second replenishment sample" was combined for estimation and analysis purposes with the Wave 7 adult and youth respondents from the Wave 4 Cohorts who were at least age 15 and in the CNP at the time of Wave 7. This combined set of Wave 7 participants, 46,169 participants in total, forms the Wave 7 Cohort. Please refer to the Restricted-Use Files User Guide that provides further details about children designated as "shadow youth" and the formation of the Wave 1, Wave 4, and Wave 7 Cohorts. Dataset 0002 (DS0002) contains the data from the State Design Data. This file contains 7 variables and 82,139 cases. The state identifier in the State Design file reflects the participant's state of residence at the time of selection and recruitment for the PATH Study. Dataset 1011 (DS1011) contains the data from the Wave 1 Adult Questionnaire. This data file contains 2,021 variables and 32,320 cases. Each of the cases represents a single, completed interview. Dataset 1012 (DS1012) contains the data from the Wave 1 Youth and Parent Questionnaire. This file contains 1,431 variables and 13,651 cases. Dataset 1411 (DS1411) contains the Wave 1 State Identifier data for Adults and has 5 variables and 32,320 cases. Dataset 1412 (DS1412) contains the Wave 1 State Identifier data for Youth (and Parents) and has 5 variables and 13,651 cases. The same 5 variables are in each State Identifier dataset, including PERSONID for linking the State Identifier to the questionnaire and biomarker data and 3 variables designating the state (state Federal Information Processing System (FIPS), state abbreviation, and full name of the state). The State Identifier values in these datasets represent participants' state of residence at the time of Wave 1, which is also their state of residence at the time of recruitment. Dataset 1611 (DS1611) contains the Tobacco Universal Product Code (UPC) data from Wave 1. This data file contains 32 variables and 8,601 cases. This file contains UPC values on the packages of tobacco products used or in the possession of adult respondents at the time of Wave 1. The UPC values can be used to identify and validate the specific products used by respondents and augment the analyses of the characteristics of tobacco products used

Note: Reporting of new COVID-19 Case Surveillance data will be discontinued July 1, 2024, to align with the process of removing SARS-CoV-2 infections (COVID-19 cases) from the list of nationally notifiable diseases. Although these data will continue to be publicly available, the dataset will no longer be updated.

Authorizations to collect certain public health data expired at the end of the U.S. public health emergency declaration on May 11, 2023. The following jurisdictions discontinued COVID-19 case notifications to CDC: Iowa (11/8/21), Kansas (5/12/23), Kentucky (1/1/24), Louisiana (10/31/23), New Hampshire (5/23/23), and Oklahoma (5/2/23). Please note that these jurisdictions will not routinely send new case data after the dates indicated. As of 7/13/23, case notifications from Oregon will only include pediatric cases resulting in death.

This case surveillance publicly available dataset has 33 elements for all COVID-19 cases shared with CDC and includes demographics, geography (county and state of residence), any exposure history, disease severity indicators and outcomes, and presence of any underlying medical conditions and risk behaviors. This dataset requires a registration process and a data use agreement.

CDC has three COVID-19 case surveillance datasets:

• COVID-19 Case Surveillance Public Use Data with Geography: Public use, patient-level dataset with clinical data (including symptoms), demographics, and county and state of residence. (19 data elements)
• COVID-19 Case Surveillance Public Use Data: Public use, patient-level dataset with clinical and symptom data and demographics, with no geographic data. (12 data elements)
• COVID-19 Case Surveillance Restricted Access Detailed Data: Restricted access, patient-level dataset with clinical and symptom data, demographics, and state and county of residence. Access requires a registration process and a data use agreement. (33 data elements)

Requesting Access to the COVID-19 Case Surveillance Restricted Access Detailed Data Please review the following documents to determine your interest in accessing the COVID-19 Case Surveillance Restricted Access Detailed Data file: 1) CDC COVID-19 Case Surveillance Restricted Access Detailed Data: Summary, Guidance, Limitations Information, and Restricted Access Data Use Agreement Information 2) Data Dictionary for the COVID-19 Case Surveillance Restricted Access Detailed Data The next step is to complete the Registration Information and Data Use Restrictions Agreement (RIDURA). Once complete, CDC will review your agreement. After access is granted, Ask SRRG (eocevent394@cdc.gov) will email you information about how to access the data through GitHub. If you have questions about obtaining access, email eocevent394@cdc.gov.

Overview

The COVID-19 case surveillance database includes individual-level data reported to U.S. states and autonomous reporting entities, including New York City and the District of Columbia (D.C.), as well as U.S. territories and affiliates. On April 5, 2020, COVID-19 was added to the Nationally Notifiable Condition List and classified as “immediately notifiable, urgent (within 24 hours)” by a Council of State and Territorial Epidemiologists (CSTE) Interim Position Statement (Interim-20-ID-01). CSTE updated the position statement on August 5, 2020, to clarify the interpretation of antigen detection tests and serologic test results within the case classification (Interim-20-ID-02). The statement also recommended that all states and territories enact laws to make COVID-19 reportable in their jurisdiction, and that jurisdictions conducting surveillance should submit case notifications to CDC. COVID-19 case surveillance data are collected by jurisdictions and reported voluntarily to CDC.

COVID-19 case surveillance data are collected by jurisdictions and are shared voluntarily with CDC. For more information, visit: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/about-us-cases-deaths.html.

The deidentified data in the restricted access dataset include demographic characteristics, state and county of residence, any exposure history, disease severity indicators and outcomes, clinical data, laboratory diagnostic test results, and comorbidities.

All data elements can be found on the COVID-19 case report form located at www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf.

COVID-19 case reports have been routinely submitted using standardized case reporting forms.

On April 5, 2020, CSTE released an Interim Position Statement with national surveillance case definitions for COVID-19 included. Current versions of these case definitions are available here: https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2021/.

CSTE updated the position statement on August 5, 2020, to clarify the interpretation of antigen detection tests and serologic test results within the case classification. All cases reported on or after were requested to be shared by public health departments to CDC using the standardized case definitions for lab-confirmed or probable cases.

On May 5, 2020, the standardized case reporting form was revised. Case reporting using this new form is ongoing among U.S. states and territories.

Data are Considered Provisional

• The COVID-19 case surveillance data are dynamic; case reports can be modified at any time by the jurisdictions sharing COVID-19 data with CDC. CDC may update prior cases shared with CDC based on any updated information from jurisdictions. For instance, as new information is gathered about previously reported cases, health departments provide updated data to CDC. As more information and data become available, analyses might find changes in surveillance data and trends during a previously reported time window. Data may also be shared late with CDC due to the volume of COVID-19 cases.
• Annual finalized data: To create the final NNDSS data used in the annual tables, CDC works carefully with the reporting jurisdictions to reconcile the data received during the year until each state or territorial epidemiologist confirms that the data from their area are correct.

Access Addressing Gaps in Public Health Reporting of Race and Ethnicity for COVID-19, a report from the Council of State and Territorial Epidemiologists, to better understand the challenges in completing race and ethnicity data for COVID-19 and recommendations for improvement.

Data Limitations

To learn more about the limitations in using case surveillance data, visit FAQ: COVID-19 Data and Surveillance.

Data Quality Assurance Procedures

CDC’s Case Surveillance Section routinely performs data quality assurance procedures (i.e., ongoing corrections and logic checks to address data errors). To date, the following data cleaning steps have been implemented:

• Questions that have been left unanswered (blank) on the case report form are reclassified to a Missing value, if applicable to the question. For example, in the question "Was the individual hospitalized?" where the possible answer choices include "Yes," "No," or "Unknown," the blank value is recoded to "Missing" because the case report form did not include a response to the question.
• Logic checks are performed for date data. If an illogical date has been provided, CDC reviews the data with the reporting jurisdiction. For example, if a symptom onset date in the future is reported to CDC, this value is set to null until the reporting jurisdiction updates the date appropriately.
• Additional data quality processing to recode free text data is ongoing. Data on symptoms, race, ethnicity, and healthcare worker status have been prioritized.

Data Suppression

To prevent release of data that could be used to identify people, data cells are suppressed for low frequency (<11 COVID-19 case records with a given values). Suppression includes low frequency combinations of case month, geographic characteristics (county and state of residence), and demographic characteristics (sex, age group, race, and ethnicity). Suppressed values are re-coded to the NA answer option; records with data suppression are never removed.

Additional COVID-19 Data

COVID-19 data are available to the public as summary or aggregate count files, including total counts of cases and deaths by state and by county. These and other COVID-19 data are available from multiple public locations:

The Ghana Demographic and Health Survey (GDHS) is a national sample survey designed to provide information on fertility, family planning and health in Ghana. The survey, which was conducted by the Statistical Service of Ghana, is part of a worldwide programme coordinated by the Institute for Resource Development/Macro Systems, Inc., in more than 40 countries in Africa, Asia and Latin America. The short-term objectives of the Ghana Demographic and Health Survey (GDHS) are to provide policymakers and those implementing policy with current data on fertility levels, knowledge and use of contraception, reproductive intentions of women 15-49, and health indicators. The information will also serve as the basis for monitoring and evaluating programmes initiated by the government such as the extended programme on immunization, child nutrition, and the family planning programme. The long-term objectives are to enhance the country's ability to undertake surveys of excellent technical quality that seek to measure changes in fertility levels, health status (particularly of children), and the extent of contraceptive knowledge and use. Finally, the results of the survey will form part of an international data base for researchers investigating topics related to the above issues.

Dataset examines long term health problems of persons and whether they have identified additional health conditions for the 2021 Census year. Australian Bureau of Statistics extracts from ABS Tablebuilder are used for the construction of the dataset.

The 1997 the Kyrgyz Republic Demographic and Health Survey (KRDHS) is a nationally representative survey of 3,848 women age 15-49. Fieldwork was conducted from August to November 1997. The KRDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Research Institute of Obstetrics and Pediatrics implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program. The purpose of the KRDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, nutritional status, and anemia. Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, and ethnicity. Additionally, the survey provides statistics on some issues not previously available in the Kyrgyz Republic: for example, breastfeeding practices and anemia status of women and children. When considered together, existing MOH data and the KRDHS data provide a more complete picture of the health conditions in the Kyrgyz Republic than was previously available. A secondary objective of the survey was to enhance the capabilities of institutions in the Kyrgyz Republic to collect, process, and analyze population and health data. MAIN FINDINGS FERTILITY Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of the Kyrgyz Republic of 3.4 children per woman. Fertility levels differ for different population groups. The TFR for women living in urban areas (2.3 children per woman) is substantially lower than for women living in rural areas (3.9). The TFR for Kyrgyz women (3.6 children per woman) is higher than for women of Russian ethnicity (1.5) but lower than Uzbek women (4.2). Among the regions of the Kyrgyz Republic, the TFR is lowest in Bishkek City (1.7 children per woman), and the highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and3.9, respectively). Time Trends. The KRDHS data show that fertility has declined in the Kyrgyz Republic in recent years. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year olds to a 38 percent decline among 35-39 year olds. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 40-49 is 4.6 children which is more than one child greater than the current TFR (3.4). Birth Intervals. Overall, 30 percent of births in the Kyrgyz Republic take place within 24 months of the previous birth. The median birth interval is 31.9 months. Age at Onset of Childbearing. The median age at which women in the Kyrgyz Republic begin childbearing has been holding steady over the past two decades at approximately 21.6 years. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20. Nearly half of married women in the Kyrgyz Republic (45 percent) do not want to have more children. Additional one-quarter of women (26 percent) want to delay their next birth by at least two years. These are the women who are potentially in need of some method of family planning. FAMILY PLANNING Ever Use. Among currently married women, 83 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30-44 (among both currently married and all women). Current Use. Overall, among currently married women, 60 percent report that they are currently using a contraceptive method. About half (49 percent) are using a modern method of contraception and another 11 percent are using a traditional method. The IUD is by far the most commonly used method; 38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills (2 percent), condoms (6 percent), and injectables and female sterilization (1 and 2 percent, respectively). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD. Source of Methods. The vast majority of women obtain their contraceptives through the public sector (97 percent): 35 percent from a government hospital, and 36 percent from a women counseling center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at women counseling centers (42 percent) or hospitals (39 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also obtain supplies from women counseling centers or (33 percent). Fertility Preferences. A majority of women in the Kyrgyz Republic (45 percent) indicated that they desire no more children. By age 25-29, 20 percent want no more children, and by age 30-34, nearly half (46 percent) want no more children. Thus, many women come to the preference to stop childbearing at relatively young ages-when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization. However, there is a deficiency of use of this method in the Kyrgyz Republic. In the interests of providing a broad range of safe and effective methods, information about and access to sterilization should be increased so that individual women can make informed decisions about using this method. INDUCED ABORTION Abortion Rates. From the KRDHS data, the total abortion rate (TAR)-the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates-was calculated. For the Kyrgyz Republic, the TAR for the period from mid-1994 to mid-1997 is 1.6 abortions per woman. The TAR for the Kyrgyz Republic is lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakhstan (1.8), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively), but higher than for Uzbekistan (0.7). The TAR is higher in urban areas (2.1 abortions per woman) than in rural areas (1.3). The TAR in Bishkek City is 2.0 which is two times higher than in other regions of the Kyrgyz Republic. Additionally the TAR is substantially lower among ethnic Kyrgyz women (1.3) than among women of Uzbek and Russian ethnicities (1.9 and 2.2 percent, respectively). INFANT MORTALITY In the KRDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992). Mortality Rates. For the five-year period before the survey (i.e., approximately mid-1992 to mid1997), infant mortality in the Kyrgyz Republic is estimated at 61 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 32 and 30 per 1,000. The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the KRDHS. Infant mortality rates based on the MOH data for the years 1983 through 1996 show a persistent declining trend throughout the period, starting at about 40 per 1,000 in the early 1980s and declining to 26 per 1,000 in 1996. This time trend is similar to that displayed by the rates estimated from the KRDHS. Thus, the estimates from both the KRDHS and the Ministry document a substantial decline in infant mortality; 25 percent over the period from 1982-87 to 1992-97 according to the KRDHS and 28 percent over the period from 1983-87 to 1993-96 according to the MOH estimates. This is strong evidence of improvements in infant survivorship in recent years in the Kyrgyz Republic. It should be noted that the rates from the survey are much higher than the MOH rates. For example, the KRDHS estimate of 61 per 1,000 for the period 1992-97 is twice the MOH estimate of 29 per 1,000 for 1993-96. Certainly, one factor leading to this difference are the differences in the definitions of a live birth and infant death in the KRDHS survey and in the MOH protocols. A thorough assessment of the difference between the two estimates would need to take into consideration the sampling variability of the survey's estimate. However, given the magnitude of the difference, it is likely that it arises from a combination of definitional and methodological differences between the survey and MOH registration system. MATERNAL AND CHILD HEALTH The Kyrgyz Republic has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women counseling centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout the rural areas. Delivery. Virtually all births in the Kyrgyz Republic (96 percent) are delivered at health facilities: 95 percent in delivery hospitals and another 1 percent in either general hospitals