Inequality in in-hospital mortality due to road traffic accident between ethnic populations in specified groups living in the same country

Abstract

Background: Road traffic accidents (RTA) are not equally distributed between ethnic groups, disproportionately affecting minorities. In Israel, Arabs are at higher risk of involvement in RTA relative to their proportion in the population. This study aims to compare the risk of in-hospital mortality from RTA between Arabs and Jews in Israel and to identify the factors associated with mortality in each population group. Methods: This study is based on the Israeli National Trauma Registry of patients hospitalized due to road traffic injuries (Injury Severity Score 16+) between 2008 and 2017. Demographic, injury and hospitalization characteristics, evacuation means and in-hospital mortality were analyzed. Hierarchical multivariate logistic regression with random intercept for the treating hospital was performed to estimate the risk of mortality. Results: Of the 11,523 hospitalizations reported, 29% were Arabs, which is higher than their proportion in the Israeli population (21%). When comparing Arabs with Jews they were younger (ages 0-24 years - 61% vs 30%), injured as a car driver (28% vs 20%) or passenger (21% vs 15%) and less likely to be a motor cyclist (8.8% vs. 19.2%). In addition, Arabs were more likely to suffer from critical injuries (51% vs 44%) and head injuries (71% vs 66%). Although Arabs were less likely to be evacuated by ambulance (68% vs 80%), they were more likely to be evacuated by a private vehicle or an emergency medical helicopter. Transfers between hospitals were greater among Arabs (14% vs 22%), as were hospital admissions "outside official work hours" (70% vs 78%) and hospital resource utilization. After accounting for demographic, injury, and hospitalization characteristics the risk of in-hospital mortality was significantly higher among Arabs compared to Jews (OR: 1.63, 95% CI: 1.14-2.32). The significantly higher mortality among Arabs was apparent in the sub-group of patients who were critically injured and in those who arrived at the hospital "outside official work hours". Conclusions: This study suggests the need for developing appropriate interventions focusing on the Arab community in general, and according to the analysis of risk groups and areas of injury in particular, including rapid access to emergency medical services and definitive care.