Regional Differences in Admission Rates of Emergency Patients Who Visited a Private General Hospital in the Capital City of Cambodia: A Three-Year Observational Study

Document Type : Original Article


1 Department of General Internal Medicine, Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia

2 Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia

3 Department of Neurosurgery, Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia

4 Department of Neurosurgery, Kitahara International Hospital, Tokyo, Japan

5 Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan

6 Department of Medicine, University of Puthisastra, Phnom Penh, Cambodia


Regional disparity is an imperative component of health disparity. In particular, providing emergency care that is equally available in rural areas is an essential part of reducing the urban–rural disparity. The objective of this study was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine their background characteristics that cause this decline.
To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness severity. The patients’ addresses were classified into 4 areas based on distance from the capital.
A total of 6167 patients who visited the emergency department at SJH between January 2017 and September 2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased with the distance from the capital. The proportion of patients who finished consultation decreased with the distance from the capital (P < .01: Chi- square test). The results of the logistic regression analysis showed that the admission rate in rural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted for age, time, and season.
The admission rate of emergency patients who visited a private general hospital in Cambodia’s capital city increased with distance from the capital city. To improve regional disparity among emergency patients, further research is necessary to identify the issues among emergency patients, especially those who are vulnerable.


  1. Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc. 2018;25(8):1080-1088. doi:10.1093/jamia/ocy052
  2. Disparities. The U.S. Department of Health and Human Services, Healthy People website. Updated August 18, 2020. Accessed July 27, 2020.
  3. Skinner L, Staiger DO, Auerbach DI, Buerhaus PI. Implications of an aging rural physician workforce. N Engl J Med. 2019;381(4):299-301. doi:10.1056/NEJMp1900808
  4. Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004;94(10):1675-1678. doi:10.2105/ajph.94.10.1675
  5. Nakahara S, Saint S, Sann S, et al. Exploring referral systems for injured patients in low-income countries: a case study from Cambodia. Health Policy Plan. 2010;25(4):319-327. doi:10.1093/heapol/czp063
  6. Belorgey N. [Emergency departments faced with social inequalities in healthcare]. Soins. 2018;63(825):20-22. doi:10.1016/j.soin.2018.03.004
  7. Morel S. Inequality and discrimination in access to urgent care in France Ethnographies of three healthcare structures and their audiences. Soc Sci Med. 2019;232:25-32. doi:10.1016/j.socscimed.2019.04.028
  8. Caines K, Shoff C, Bott DM, Pines JM. County-level variation in emergency department admission rates among US Medicare beneficiaries. Ann Emerg Med. 2016;68(4):456-460. doi:10.1016/j.annemergmed.2016.03.019
  9. Pines JM, Mutter RL, Zocchi MS. Variation in emergency department admission rates across the United States. Med Care Res Rev. 2013;70(2):218-231. doi:10.1177/1077558712470565
  10. Leira EC, Hess DC, Torner JC, Adams HP, Jr. Rural-urban differences in acute stroke management practices: a modifiable disparity. Arch Neurol. 2008;65(7):887-891. doi:10.1001/archneur.65.7.887
  11. Khan A, Penoff BT, Pirrotta EA, Hosang R. Shifting the paradigm of emergency care in developing countries. Cureus. 2018;10(2):e2219. doi:10.7759/cureus.2219
  12. Yan LD, Mahadevan SV, Yore M, et al. An observational study of adults seeking emergency care in Cambodia. Bull World Health Organ. 2015;93(2):84-92. doi:10.2471/blt.14.143917
  13. Anderson PD, Suter RE, Mulligan T, Bodiwala G, Razzak JA, Mock C. World Health Assembly Resolution 60.22 and its importance as a health care policy tool for improving emergency care access and availability globally. Ann Emerg Med. 2012;60(1):35-44.e3. doi:10.1016/j.annemergmed.2011.10.018
  14. Maher D, Ford N, Unwin N. Priorities for developing countries in the global response to non-communicable diseases. Global Health. 2012;8:14. doi:10.1186/1744-8603-8-14
  15. CAMBODIA–WHO, Country Cooperation Strategy 2016–2020. World Health Organization website. Accessed April 16, 2020.
  16. World Health Organization. The Kingdom of Cambodia Health System Review. Manila: WHO Regional Office for the Western Pacific; 2015. Accessed April 16, 2020.
  17. Zhu A, Tang S, Thu NTH, Supheap L, Liu X. Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes. Hum Resour Health. 2019;17(1):2. doi:10.1186/s12960-018-0340-6
  18. Ozano K, Simkhada P, Thann K, Khatri R. Improving local health through community health workers in Cambodia: challenges and solutions. Hum Resour Health. 2018;16(1):2. doi:10.1186/s12960-017-0262-8
  19. Kobashi Y, Chou K, Slaiman N, et al. Improving the rural-urban balance in Cambodia's health services. Int J Health Policy Manag. 2020. doi:10.34172/ijhpm.2020.136
  20. Cambodia demographic and health survey 2014. Ministry of Planning MoH website. Accessed April 16, 2020.
  21. Study report on emergency medical care in Cambodia. The Sasakawa Peace Foundation website. Accessed August 20, 2020.
  22. Venkatesh AK, Dai Y, Ross JS, Schuur JD, Capp R, Krumholz HM. Variation in US hospital emergency department admission rates by clinical condition. Med Care. 2015;53(3):237-244. doi:10.1097/mlr.0000000000000261
  23. Lo AX, Donnelly JP, Durant RW, et al. A national study of US emergency departments: racial disparities in hospitalizations for heart failure. Am J Prev Med. 2018;55(5 Suppl 1):S31-S39. doi:10.1016/j.amepre.2018.05.020
  24. Long SJ, Fone D, Gartner A, Bellis MA. Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales. BMJ Open. 2016;6(8):e011169. doi:10.1136/bmjopen-2016-011169
  25. Noree T, Hanefeld J, Smith R. Medical tourism in Thailand: a cross-sectional study. Bull World Health Organ. 2016;94(1):30-36. doi:10.2471/blt.14.152165
  26. Orach CG. Health equity: challenges in low income countries. Afr Health Sci. 2009;9 Suppl 2:S49-51.
Volume 11, Issue 8
August 2022
Pages 1425-1431
  • Receive Date: 31 August 2020
  • Revise Date: 26 December 2020
  • Accept Date: 14 April 2021
  • First Publish Date: 18 May 2021