Research Article: Correlates of hospitalizations in internal medicine divisions among Israeli adults of different ethnic groups with hypertension, diabetes and cardiovascular diseases

Date Published: April 24, 2019

Publisher: Public Library of Science

Author(s): Shira Sagie, Wasef Na’amnih, Juda Frej, Daniel Cohen, Gershon Alpert, Khitam Muhsen, Sandra C. Buttigieg.


Disparities 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.

A 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.

Overall, 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). In 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.

Partial Text

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]. Disparities in health and in NCDs exist between and within countries, and they are affected by social determinants, including education, income and ethnicity [3–8].

During the study period (2008), there were 28,393 patients (mean age 63.1 years standard deviation [SD] 12.3), 52.2% women) who met the study inclusion criteria. The study sample consisted of 63.2% Jewish patients and 36.8% Arab patients. The mean age of the Arab patients was lower than that of Jewish patients by 7 years: 58.3 (SD 11.3) and 65.9 (SD 12.1) years, respectively (P<0.001). Arab and Jewish patients were comparable regarding sex distribution (53.8% and 51.3% were women, respectively). Arab patients lived in towns of lower SES rank than Jewish participants (mean 3.0 [SD 0.9] vs. 6.0 [SD 0.5], P<0.001). We examined the correlates of hospitalizations in internal medicine divisions among adults with hypertension, diabetes and CVD, utilizing the database of the largest health maintenance organization in Israel.   Source:


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