Abstract
BackgroundDisparities in non-communicable diseases (NCDs) may affect health care utilization. We compared the correlates of hospitalizations in internal medicine divisions, of adults with NCDs, between the main population groups in Israel.MethodsA cross-sectional study was conducted among Jews (N = 17,952) and Arabs (N = 10,441) aged ≥40 years with diabetes, hypertension or cardiovascular diseases, utilizing the computerized database of the largest health maintenance organization in Israel. Information was retrieved on sociodemographics, background diseases, hospitalizations and utilizations of other health services. Multivariable log binomial regression models were performed.ResultsOverall, 3516 (12.4%) patients were hospitalized at least once during a one-year period (2008). Hospitalization in internal medicine divisions was more common among Arab than Jewish patients; prevalence ratio 1.24 (95% CI 1.14–1.35), and increased with age (P<0.001). An inverse association was found between residential socioeconomic status and hospitalization among Jewish patients, but not among Arab, who lived mostly in low socioeconomic status communities. In both population groups, congestive heart failure, arrhythmias, heart surgery, cardiac catheterization, kidney disease, asthma, neurodegenerative diseases, mental illnesses, smoking (in men) and disability were positively related to hospitalization in internal medicine divisions, which was more common also in patients who consulted any specialist and a specialist in cardiology. Emergency room visits, consulting with an ophthalmologist and performing cancer screening tests were inversely related to hospitalizations among Jewish patients only (P = 0.009 and P = 0.067 for interaction, respectively).ConclusionsIn a country with universal health insurance, the correlates of hospitalizations included sociodemographics, multi-morbidity, health behaviors and health services use patterns. Socioeconomic disparities might account for ethnic differences in hospitalizations. Individuals with several NCDs, rather than one specific disease, disability and smoking should be targeted to reduce healthcare costs related to hospitalizations.
Highlights
Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), cancer, chronic respiratory diseases and diabetes, account for 70% of deaths worldwide; CVD is considered the cause of 31% of all deaths [1]
Hospitalization in internal medicine divisions was more common among Arab than Jewish patients; prevalence ratio 1.24, and increased with age (P
An inverse association was found between residential socioeconomic status and hospitalization among Jewish patients, but not among Arab, who lived mostly in low socioeconomic status communities
Summary
Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), cancer, chronic respiratory diseases and diabetes, account for 70% of deaths worldwide; CVD is considered the cause of 31% of all deaths [1]. Behavioral risk factors such as physical inactivity, smoking and poor diet explain nearly 80% of the CVD burden, making these diseases and their risk factors a main target for interventions [2]. The higher mortality rates of heart diseases, stroke and diabetes among the Arab population [10] contribute substantially to the gap in life expectancy between the two population groups [14, 15]. We compared the correlates of hospitalizations in internal medicine divisions, of adults with NCDs, between the main population groups in Israel
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