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Abstract
BackgroundJapan’s historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation.MethodsA secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or intensive-care unit or high-care unit admission to the emergency department at the Tokyo Medical and Dental University medical hospital from 2010 through 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted.ResultsNon-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio [aOR] 2.7; 95% confidence interval [CI], 1.7–4.4) and infectious disease diagnoses (aOR 2.2; 95% CI, 1.3–3.7), and marginally more burn diagnoses (aOR 2.3; 95% CI, 0.96–5.3) than Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment.ConclusionThere were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.
Highlights
Japan has seen a recent surge of non-Japanese tourists and residents due to globalization and revised immigration[1] and workstatus policies.[2]
There is ample research abroad, such as the United States,[6] Canada,[7] Korea,[8] Germany,[9] and Finland,[10] that has focused on immigrant patient care outcomes; Japan has had significantly less immigrant patients than most nations,[11] and its healthcare system is nascent in non-Japanese patient care
Japan has had low immigration rates and has the lowest percentage of foreign-born residents in the world among developed nations,[17,18] suggesting far fewer cases and less experience working with non-nationals
Summary
Japan has seen a recent surge of non-Japanese tourists and residents due to globalization and revised immigration[1] and workstatus policies.[2]. There is ample research abroad, such as the United States,[6] Canada,[7] Korea,[8] Germany,[9] and Finland,[10] that has focused on immigrant patient care outcomes; Japan has had significantly less immigrant patients than most nations,[11] and its healthcare system is nascent in non-Japanese patient care. Japan’s healthcare system is an excellent ecosystem to better understand issues related to non-national patient care and language and cultural barriers.[12–15]. Japan has had low immigration rates and has the lowest percentage of foreign-born residents in the world among developed nations,[17,18] suggesting far fewer cases and less experience working with non-nationals. Japan’s historically low immigration rate and monolingual culture makes it a interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation
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