Prevalence, Correlates, and Time Trends of Multiple Chronic Conditions Among Israeli Adults: Estimates From the Israeli National Health Interview Survey, 2014-2015.

INTRODUCTION: Chronic diseases constitute a major public health challenge. The prevalence of multiple chronic conditions (MCC) has increased. The objective of our study was to describe the prevalence, correlates, and time trends of MCC in the Israeli population and among the nation's 2 main population groups (Jewish and Arab). METHODS: To describe the prevalence of correlates of MCC, we used data from the 2014-2015 Israeli National Health Interview Survey-III (INHIS-III). MCC was defined as having 2 or more of the following 10 self-reported physician-diagnosed chronic conditions: asthma, arthritis, cancer, diabetes, dyslipidemia, heart attack, hypertension, migraine, osteoporosis, or thyroid disease. For trend analysis, we used data from INHIS-I (2003-2004) and INHIS-II (2007-2010). Logistic regression was used for multivariate analysis. Estimates were weighted to the 2014 Israeli population. P for trend was calculated by using the Cochran-Armitage test for proportions. RESULTS: In 2014-2015, the prevalence of MCC was 27.3% (95% confidence interval, 25.7%-28.8%). In multivariate analysis, MCC was associated with older age, female sex, a monthly household income of USD$3,000 or less, current and past smoking, and overweight or obesity. After adjusting for age, sex, income, smoking status, and body mass index, differences in MCC between Jewish and Arab populations disappeared. Dyslipidemia and hypertension were the most prevalent dyad among both men and women. Dyslipidemia, hypertension, and diabetes were the most prevalent triad among both men and women. The age-adjusted prevalence of MCC increased by 6.7% between 2003-2004 and 2014-2015. CONCLUSION: With the increase in the prevalence of MCC, a comprehensive approach is needed to reduce the burden of chronic conditions. Of special concern are the groups most prone to MCC.

Cigarette smoking and correlates among ultra-orthodox Jewish males.

INTRODUCTION: Ultra-orthodox Jews compose a segregated group that struggles to preserve its centuries-old way of life by strictly adhering to the Jewish religious law in every aspect of life. Their health habits were infrequently studied to date. We sought to determine the smoking prevalence and to find its significant correlates in the ultra-orthodox Jewish population of Israel. METHODS: The study was conducted in a cross-sectional design of men as smoking prevalence among ultra-religious women was found to be negligible in previous studies. Following a random ultra-orthodox households sampling and a phone survey, a total of 782 adult men were recruited. RESULTS: The age-adjusted smoking prevalence was 12.8% (95% confidence interval [CI] = 10.3%-15.3%). The multivariate model demonstrated that being single (odds ratio [OR] = 5.83; 95% CI = 2.44-13.98), being of Israeli (OR = 2.10; 95% CI = 1.18-3.71), or North African/Asian origin (OR = 2.92; 95% CI = 1.55-5.53) was positively correlated with smoking while being a full-time Yeshiva student (OR = 0.51; 95% CI = 0.30-0.85) was negatively correlated with smoking. CONCLUSION: The Israeli ultra-orthodox Jewish men have very low prevalence of smoking when compared with the general population. The study contributes to a better understanding of habitual smoking correlates in ultra-religious minorities.

[Assessment of community health care services delivery during operation "Cast Lead"--a cross sectional survey].

BACKGROUND: On December 27th, 2008, the Israeli Defense Forces initiated operation "Cast Lead", aiming to strike the infrastructure of the terror organizations in the Gaza Strip. An emergency situation was declared on the home front, allowing the security forces special jurisdiction over the area. The Home Front Command's Medical Operation Center, in cooperation with the Superior National Health Authority of the Ministry of Health, coordinated the delivery of community health services. OBJECTIVE: The objective of this study was to evaluate the delivery of community health services to the Israeli civilian population living in proximity to the Gaza Strip during operation "Cast Lead". METHODS: A telephone household survey was initiated on the 20th day of the operation until two days after a cease-fire was declared. The sample was drawn from the Jewish population living within a radius of 40 kilometers from the Gaza Strip. Questions included the need and use of health care services, satisfaction with health care services and demographic variables. RESULTS: Overall, 901 interviews were conducted. Findings revealed that: 91.3%, 76.2% and 89.6% of those who needed primary physician, a specialist or a renewal of a drug prescription received these services, respectively; 87.1% of those who needed medical emergency services received them. The reported satisfaction with health care services during the combat period was very high; 91% reported high or very high satisfaction with their HMO's function during that period. CONCLUSIONS: The delivery of community health care services during operation "Cast Lead" efficiently addressed the needs of the population in the area. The delivery of medical emergency services and the access to medical specialists should be reassessed. It is important to plan ahead surveys such as the survey described above, and to cooperate with the HMO's and the Israel Defense Forces (IDF) in order to improve emergency preparedness.

Factors associated with childhood influenza vaccination in Israel: a cross-sectional evaluation.

BACKGROUND: Vaccinating children against influenza has shown both direct and indirect beneficial effects. However, despite being offered free of charge, childhood influenza vaccine coverage in Israel has been low. Our objective was to evaluate the factors associated with childhood influenza vaccination in Israel. METHODS: A cross-sectional language-specific telephone survey was conducted among adults 18 years or older, to examine childhood influenza vaccination practices and their associations with socio-demographic and relevant health variables. We further explored the reasons for these practices among parents. Multivariate logistic regression was used to identify factors associated with childhood influenza vaccine acceptance. RESULTS: Of a total of 6518 individuals contacted by mobile phone, 1165 eligible parents, ≥18 years old with children 1-18 years of age, were interviewed, and 1040 of them completed the survey successfully. Overall, factors associated with childhood influenza vaccination were younger child's age, influenza vaccination of other family members and belonging to the Arab population group. No association was found between childhood influenza vaccination and routine childhood vaccine uptake. Several of the parents' reasons for vaccine acceptance - preventing influenza or its transmission, awareness regarding the need for influenza vaccination and receipt of invitation to get vaccinated - differed significantly between Jewish and Arab parents. Several reasons reported by parents for not vaccinating children against influenza, indicated a likelihood to accept influenza vaccine outreach efforts. Such reasons were reported by 27.5% of Jewish parents and 37.5% of Arab parents. CONCLUSIONS: We found that certain demographic factors were associated with childhood influenza vaccination in Israel. Several reasons described by the parent for not vaccinating their children indicate that outreach efforts are likely to increase childhood influenza vaccination. Addressing population group-specific needs is recommended to optimize the success of influenza vaccine outreach efforts.

Factors Associated with Breast Cancer Screening in a Country with National Health Insurance: Did We Succeed in Reducing Healthcare Disparities?

BACKGROUND: The effectiveness of breast cancer screening programs in reducing mortality is well established in the scientific literature. The National Breast Cancer Screening Program in Israel provides biennial mammograms for women of average risk aged 50-74 and annual mammograms for women aged 40-49 at higher risk. Compliance is high, but differential. This study explores different factors associated with breast cancer screening attendance among women aged 40-74 years. MATERIALS AND METHODS: Two main outcomes were studied: ever been screened and been screened in the 2 years preceding the study, using the cross-sectional Knowledge, Attitudes and Practices (KAP) Survey conducted in 2010-2012 among 2575 Israeli women aged 21+ years. The independent variables were sociodemographic characteristics, perceived health status, lifestyle habits, and healthcare fund membership. Bivariate and multivariable logistic regressions were conducted. RESULTS: Of the 943 participants aged 50-74, 87% had ever been screened and 74.8% had attended screening for breast cancer in the last 2 years. In multivariable models, Jewish compared to Arab women (adjusted prevalence ratio [APR] = 2.09, 95% confidence interval [CI]: 1.02-4.32), and unmarried compared to married women (APR = 2.9, 95% CI: 1.2-7.2), were more likely to have ever been screened. The only factor associated with breast cancer screening in the 2 years preceding the study was healthcare fund membership. In women aged 40-49 years, ethnicity was the only contributing factor associated with breast cancer screening, with higher screening rates in the 2 years preceding the study in Jewish versus Arab women (APR = 3.7, 95% CI: 1.52-9.3). CONCLUSIONS: Breast cancer screening attendance in Israel is high. However, significant differences are observed by membership of healthcare fund and by ethnicity, calling for better targeted outreach programs at this level.

Self-Reported Type 2 Diabetes and Diabetes-Related Eye Disease in Jews and Arabs in Israel.

Prevalence rates of diabetes and its complications may be higher in minorities. We assessed these rates in Jews and Arabs living in Israel. Data were pooled from the first and second Israeli national health interview surveys. 9625 Jews and 2401 Arabs participated in the analysis. The age adjusted rate of self-reported diabetes was 10.7 % among Arabs and 5.7 % among Jews [odds ratio (OR) 2.14, 95 % confidence interval 1.77-2.60]. After adjustment for risk factors the OR decreased to 1.28 (95 % CI 1.04-1.59). The rate of self-reported diabetes-related eye disease was 37.6 % among Arabs with diabetes and 18.3 % among Jews (OR 2.69, 95 % CI 1.84-3.93). After adjustment the odds among Arabs were still double that of Jews (OR 2.26, 95 % CI 1.44-3.56). Self-reported type 2 diabetes and diabetes-related eye disease were higher among Arabs. Multi-disciplinary and cultural sensitive approach is required in order to improve diabetes care among the Arab population.