Ethnic disparities in emergency department utilization patterns in southern Israel: a population-based study

Approximately 520,000 residents (30 % Bedouins) inhabit the Negev region of southern Israel. Despite the geographical proximity, Bedouins differ from Jews demographically and socio-economically. To evaluate the ethnic disparities in emergency department (ED) utilization patterns in this population-based observational retrospective cohort study, individual data regarding 93,338 visits to the ED throughout 2007-2009 (9 months) were obtained. Demographic data were obtained from the Central Bureau of Statistics. The age- and gender-adjusted annual rates of ED visits were: 31.1 and 23 per 100 residents for Bedouins and Jews, respectively (P < 0.001). Significant differences in visiting patterns according to the weekday and time of day between these groups were observed. Bedouins were referred at a higher rate by a physician compared with Jews (81 vs. 61 %; P < 0.001). Ethnic disparities in chief complaints including the following age-adjusted odds ratio values of Bedouins compared with Jews were found: respiratory [Adj OR 1.38 (95 % CI 1.31-1.46)], fever [Adj OR 0.67 (95 % CI 0.64-0.71)], and cardiovascular [Adj OR 1.23 (95 % CI 1.16-1.32)] in Bedouins versus Jews, respectively (P < 0.001 each). Multivariate analysis demonstrated a higher risk for in-hospital admission among Bedouins than Jews [Adj OR 1.52 (95 % CI 1.47-1.58); P < 0.001]. Utilization patterns of EDs of Bedouins and Jews differ. Potential etiologies are increased morbidity, reduced accessibility to primary care clinics, use of private often non-board-certified physicians, and decreased socio-economic status among Bedouins. This warrants further research and interventional programs dealing with causes of the disparities.