Comparison of disease patterns and outcomes between non-Japanese and Japanese patients at a single tertiary emergency care center in Japan.

Ishii, Euma; Nawa, Nobutoshi; Matsui, Hiroki; Otomo, Yasuhiro; Fujiwara, Takeo

BACKGROUND Japan's historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation. METHODS A secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or ICU or HCU admission to the ED at the Tokyo Medical and Dental University medical hospital between 2010 to 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted. RESULTS Non-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio (aOR) 2.7 (95% confidence interval (CI): 1.7, 4.4) and infectious disease diagnoses (aOR 2.2 (95% CI: 1.3, 3.7)), and marginally more burn diagnoses (aOR 2.3 (95% CI: 0.96, 5.3)) over Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment. CONCLUSION There were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.