Shashar Sagi, Zeldetz Vladimir, Shalev Aryeh, Barret Orit, Press Yan, Shamia David, Punchik Boris
Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva, 84101, Israel.
Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel.
Int J Equity Health. 2025 Mar 10;24(1):66. doi: 10.1186/s12939-025-02427-0.
ST-Elevation Myocardial Infarction (STEMI) is a critical condition, especially in the older population, who are at increased risk due to comorbidities and delayed diagnosis. This study aimed to investigate the impact of ethnicity on the clinical characteristics, treatment timelines, and outcomes of older patients with STEMI in southern Israel, comparing Jewish and Bedouin populations.
We conducted a retrospective cohort study at Soroka University Medical Center from 2016 to 2022, including older patients (≥ 65 years) diagnosed with STEMI. Patients were grouped by ethnicity: Jews and Bedouins. Data on demographics, comorbidities, treatment timelines, and clinical outcomes were collected. Statistical analysis included a comparison analysis and a multivariable logistic regression, adjusting for potential confounders.
575 older patients diagnosed with STEMI were included in the study, of them 469 Jews (81.6%) and 106 Bedouins (18.4%). The mean age of the cohort was 74.35 ± 7.33 years, with no significant difference between Jews (74.56 years 7.53) and Bedouins (73.40 ± 5.99 years, p = 0.139). Bedouins had higher rates of diabetes (53.8% vs. 40.7%, p = 0.019) and smoking (40.6% vs. 27.9%, p = 0.015) and were less likely to arrive by ambulance (39.6% vs. 62.5%, p < 0.00). Bedouins also experienced longer median times from pain onset to first medical contact (126.5 min vs. 90.0 min, p = 0.006) and total ischemic time (240.0 min vs. 205.0 min, p = 0.003). Despite these differences, there were no significant differences in in-hospital mortality (13.2% Bedouins vs. 10.9% Jews, p = 0.606), 30-day mortality (14.2% Bedouins vs. 11.5% Jews, p = 0.556), or one-year mortality (21.7% Bedouins vs. 20.9% Jews, p = 0.959). Multivariable analysis confirmed no significant association between ethnicity and mortality outcomes.
Despite the higher prevalence of comorbidities among Bedouin patients, less likely to arrive by ambulance, and experienced longer delays in receiving care, their mortality outcomes were comparable to Jewish patients. These findings highlight the effectiveness of the acute care system in southern Israel. However, further research is needed to explore potential differences in other outcomes, such as quality of life and functional recovery, to better address healthcare disparities in this population.
ST段抬高型心肌梗死（STEMI）是一种危急病症，在老年人群中尤为如此，由于合并症和诊断延迟，他们面临的风险更高。本研究旨在调查种族对以色列南部老年STEMI患者的临床特征、治疗时间和结局的影响，比较犹太人和贝都因人群体。
我们于2016年至2022年在索罗卡大学医学中心进行了一项回顾性队列研究，纳入诊断为STEMI的老年患者（≥65岁）。患者按种族分组：犹太人和贝都因人。收集了人口统计学、合并症、治疗时间和临床结局的数据。统计分析包括比较分析和多变量逻辑回归，并对潜在混杂因素进行了调整。
575例诊断为STEMI的老年患者纳入研究，其中469例犹太人（81.6%）和106例贝都因人（18.4%）。队列的平均年龄为74.35±7.33岁，犹太人和贝都因人之间无显著差异（犹太人74.56岁±7.53岁，贝都因人73.40±5.99岁，p = 0.139）。贝都因人的糖尿病患病率（53.8%对40.7%）和吸烟率（40.6%对27.9%）较高，乘坐救护车就诊的可能性较小（39.6%对62.5%，p < 0.00）。贝都因人从疼痛发作到首次医疗接触的中位时间（126.5分钟对90.0分钟，p = 0.006）和总缺血时间（240.0分钟对205.0分钟，p = 0.003）也更长。尽管存在这些差异，但住院死亡率（贝都因人13.2%对犹太人10.9%，p = 0.606）、30天死亡率（贝都因人14.2%对犹太人11.5%，p = 0.556）或1年死亡率（贝都因人21.7%对犹太人20.9%，p = 0.959）无显著差异。多变量分析证实种族与死亡率结局之间无显著关联。
尽管贝都因患者合并症患病率较高，乘坐救护车就诊的可能性较小，接受治疗的延迟时间较长，但其死亡率结局与犹太患者相当。这些发现凸显了以色列南部急性护理系统的有效性。然而，需要进一步研究探索其他结局（如生活质量和功能恢复）的潜在差异，以更好地解决该人群的医疗保健差距问题。
