Differences between Bedouin and Jewish populations in incidence and characteristics of patients hospitalized with community-acquired pneumonia

Abstract

Objective: Southern Israel is inhabited by two ethnic groups: predominantly urban Jews and semi-nomad Bedouin Arabs. We evaluated the incidence of hospitalization and differences in clinical characteristics of community-acquired pneumonia (CAP) between these populations.

Design: A hospital-based prospective observational study at Soroka Medical Center, a 1200-bed tertiary care hospital, the single hospital in the region.

Patients: All patients admitted with CAP to the internal medicine division during a 5-month winter period.

Results: 262 patients were enrolled, of whom 58 (22.1%) were Bedouins. Age-standardized incidence rate for CAP hospitalization among Jews was 68 cases per 100,000 during one winter period, compared to 284 per 100,000 among Bedouins. Bedouin patients were younger than Jewish patients (60.0 +/- 20 vs. 66 +/- 17 years, P = .05). Jews had lower rates of smoking (19.1%, vs. 39.7% P = .001), chronic obstructive pulmonary disease (9.3% vs. 31.0%, P = .001) and diabetes (25.0% vs 41.4%, P = .01). Bedouin patients had a lower rate of pre-hospitalization antibiotic therapy (12.1% vs. 25.5%, P = .03) and influenza vaccination (14.0 vs. 26.8, P = .01). Despite these differences, severity of disease, (measured by Pneumonia Outcome Research Team score), length of hospitalization (median 4 days, P = .38) and 30-day mortality rate (3.4% vs. 8.8%, P = .18) were similar in both populations.

Conclusions: We found a higher incidence of CAP hospitalizations in Bedouin Arabs compared to the Jews. Higher rates of smoking, chronic obstructive pulmonary disease, and lower rates of influenza vaccination most likely contribute to this difference. Despite socioeconomic and clinical differences between the two ethnic groups, no difference was found in the clinical outcomes.