Determinants of hospitalization among Indonesian Hajj pilgrims in Saudi Arabia: a nationwide retrospective cohort study.

BACKGROUND: The Hajj pilgrimage is a major global gathering that poses health challenges, particularly for those with pre-existing health conditions that require hospitalization. OBJECTIVES: To examine the determinants of hospitalization among Indonesian Hajj pilgrims and quantify their relative contributions to the burden of hospitalization. DESIGNS: Retrospective cohort study. SETTING: Indonesian emergency clinics and referral hospitals for Hajj in Saudi Arabia during the 2016-2019 and 2022 Hajj seasons. PATIENTS AND METHODS: A nationwide retrospective cohort study used data from the Integrated Hajj Computerized System for Health (Siskohatkes). Variables included demographic information, clinical profiles, and hospitalization outcomes. Multivariate logistic regression to estimate the adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated, and population-attributable fractions quantified significant determinants. MAIN OUTCOME MEASURES: Hospitalization among Indonesian Hajj pilgrims during the Hajj period. SAMPLE SIZE: 876 700 Indonesian Hajj pilgrims were included in this study. RESULTS: Overall, 8978 pilgrims (1.02%) were hospitalized. Age was the strongest predictor of hospitalization, with pilgrims aged ≥65 years having more than eightfold higher odds of hospitalization than those aged <45 years (aOR=8.31; 95% CI: 7.39-9.34; P<.001), accounting for 49.8% of the attributable risk. Male sex was also independently associated with hospitalization (aOR=1.47; 95% CI: 1.39-1.56; P<.001), contributing 11.6% of the attributable risk. Among comorbidities, diabetes (aOR=2.34; 95% CI: 2.19-2.51; P<.001), diabetes with hypertension (aOR=2.23; 95% CI: 2.07-2.39; P<.001), and anemia (aOR=1.56; 95% CI: 1.48-1.63; P<.001) were significant independent predictors of hospitalization. The most common primary diagnoses among hospitalized pilgrims were pneumonia (36.7%), chronic obstructive pulmonary disease (21.4%), and myocardial infarction/coronary heart disease (12.4%). CONCLUSION: Older age and cardiometabolic comorbidities were the major predictors of hospitalization among Indonesian Hajj pilgrims. Strengthening pre-departure screening, chronic disease management, and risk-based interventions may reduce preventable hospitalizations and improve pilgrim safety. LIMITATIONS: Potential for information bias inherent in routinely collected administrative data and limited availability of clinical and behavioral covariates.