King Abdulaziz University, Faculty of Medicine, Saudi Arabia; University of California, Los Angeles, USA.
University of California, Los Angeles, USA.
J Infect Public Health. 2024 Apr;17 Suppl 1:49-61. doi: 10.1016/j.jiph.2023.05.021. Epub 2023 Jun 3.
The Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Little is known about the impact of the existing chronic diseases on morbidity and mortality during the Hajj. Furthermore, the quality of services provided by Hajj hospitals warrants further study. This study aims to describe patterns of inpatient, all-cause mortality during the Hajj and the relationship between mortality and preexisting chronic diseases as well as the services provided in Hajj hospitals.
The population included pilgrims who were admitted to Hajj hospitals in Makkah and sacred sites between 2012 and 2017, excluding 2015. A retrospective, matched, case-control study design was utilized. 2237 cases of mortality were matched to 4474 control cases based on age and gender. The data were extracted from hospital admissions offices and medical records. Hierarchical, logistic regression models were used to examine the medical services. The effect measure modification of the copresence of more than one chronic disease was also examined.
The rate of inpatient all-cause mortality was higher in Makkah hospitals compared to sacred site hospitals. Inpatient, all-cause mortality was significantly associated with diabetes, hypertension, and cardiovascular diseases. Effect measure modification was present between diabetes and cardiovascular diseases, hypertension, and cardiovascular diseases, but not between diabetes and hypertension. Patients who received medical services were more likely to die during their hospital stay compared to patients not receiving services.
The current focus on public health issues during the Hajj should be equally distributed between communicable and non-communicable diseases. Although advanced services are provided by Hajj hospitals, interventions to address the increased risks, including mortality, faced by pilgrims with preexisting, chronic diseases should be further investigated and considered.
沙特 2030 愿景预测到 2030 年每年将有 3000 万朝圣者参加。在朝觐期间提供具有成本效益的医疗服务对于管理朝圣者人数的增加至关重要。目前对现有慢性病对朝觐期间发病率和死亡率的影响知之甚少。此外，朝觐医院提供的服务质量还需要进一步研究。本研究旨在描述朝觐期间住院患者的发病模式、全因死亡率以及死亡率与原有慢性病之间的关系以及朝觐医院提供的服务。
研究人群包括 2012 年至 2017 年期间在麦加和圣地的朝觐医院住院的朝圣者，但不包括 2015 年。采用回顾性、匹配的病例对照研究设计。根据年龄和性别，将 2237 例死亡病例与 4474 例对照病例相匹配。数据取自医院入院办公室和病历。采用分层逻辑回归模型检查医疗服务。还检查了同时存在多种慢性病的影响衡量修饰作用。
与圣地医院相比，麦加医院的住院全因死亡率更高。住院全因死亡率与糖尿病、高血压和心血管疾病显著相关。在糖尿病与心血管疾病、高血压与心血管疾病之间存在效应量修饰作用，但在糖尿病与高血压之间没有这种作用。与未接受服务的患者相比，接受医疗服务的患者在住院期间死亡的可能性更高。
目前朝觐期间的公共卫生重点应在传染病和非传染病之间均等分配。尽管朝觐医院提供了先进的服务，但应进一步调查和考虑针对有原有慢性病的朝圣者增加的风险（包括死亡率）的干预措施。
