Abstract
ObjectiveTo determine if ethnic disparities exist with regard to the risk of injury and injury outcomes among elderly hospitalized casualties in Israel.MethodsA retrospective study based on data from the Israeli National Trauma Registry between 2008 and 2017. Data included demographic, injury and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences between Jewish and Arab casualties, aged 65 and older.ResultThe study included 96,795 casualties. The proportion of elderly hospitalized casualties was 2.8 times greater than their proportion in the population (3.1 times greater among Jews and 2.1 times among Arabs). In comparison to Arabs, Jews suffered from a greater percentage of head injuries (10.5 and 8.9%, respectively for Jews and Arabs p < .001), but fewer extremity injuries (46.7% vs. 48.0% respectively for Jews and Arabs p < .05). Among severe/critical casualties and among casualties with severe head injuries, Arabs were more likely to be transported to the hospital in a private car (27% vs. 21% respectively for Arabs and Jews p < .001; 30.5% vs. 23.3% respectively for Arabs and Jews p < .001). Logistic regression analysis, adjusted for age, gender, injury severity, type of injury, type of trauma center and year of admission, shows that Jews, relative to Arabs, were more likely to be hospitalized for more than seven days, admitted to the intensive care unit (ICU) and to be discharged to a rehabilitation center (OR: 1.3, 1.3 and 2.4 respectively). No differences regarding surgery (OR: 0.95) or in-hospital mortality (OR: 0.99) were found.ConclusionsEthnic disparities between Jewish and Arab hospitalized casualties were observed with regard to hospital stay, ICU admission and rehabilitation transfer. However, no differences were found with regard to mortality and surgery. While the reported disparities may be due in part by cultural differences and accessibility, health policy decision makers should aim to reduce the gaps by optimizing the accessibility of ambulance and rehabilitation services as well as increasing awareness regarding the availability of these medical services among the Arab population.
Highlights
The elderly population continues to expand, resulting in a greater number of geriatric patients being at risk for injury [1]
In 2016, the prevalence of hospitalization due to injury for ages 65–79 was higher among Arabs compared to Jews, (p < .05) with no significant differences among the age group 80+ (Fig. 1)
Our results are in partial discrepancy with other international findings which find that there are disparities in the risk of injury and health outcomes between ethnic groups [3, 5,6,7,8, 16].These disparities may be attributed to cultural, safety and behavioral differences [17]
Summary
The elderly population continues to expand, resulting in a greater number of geriatric patients being at risk for injury [1]. In comparison to younger patients, outcomes following injury are significantly worse among the geriatric population, resulting in disproportionate healthcare utilization and expenditures. Disparities in the risk of injury and health outcomes between ethnic groups have been demonstrated in a number of countries around the world. Minority ethnic groups are often at higher risk than the majority of the population [3,4,5,6,7,8]. A recent study from the United States has demonstrated that trauma casualties among minority populations are clustered in hospitals with higher than expected mortality [9]. Research among the non-American trauma patient population has been limited [11]
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