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Country Factors Associated With the Risk of Hospitalization and Aeromedical Evacuation Among Expatriate Workers

Druckman, Myles MD; Harber, Philip MD, MPH; Liu, Yihang MD, MS, MA; Quigley, Robert L. MD, DPhil

Journal of Occupational and Environmental Medicine: September 2012 - Volume 54 - Issue 9 - p 1118–1125
doi: 10.1097/JOM.0b013e3182677d75
Original Articles

Objective: To assess country factors associated with the risk of requiring aeromedical evacuation and hospitalization among expatriate workers and their dependents.

Methods: The 2009–2010 data including 5725 aeromedical evacuations and 17,828 hospitalizations, and 2009 data of hospitalizations and aeromedical evacuations among 94,651 at-risk expatriates, were analyzed to assess 2 country risk rating tools. Each tool utilized four risk categories and reflected level of development and medical capabilities.

Results: Country risk category was strongly associated with risk of evacuation and/or hospitalization for each risk rating tool (eg, 46-fold increase from lowest to highest country risk category).

Conclusion: Country risk tools strongly associate hospitalization and aeromedical evacuation with country risk category, and thus can be important indicators of relative medical risk. Employers may use these results to implement targeted prevention programs to support expatriate workers and their families.

From the International SOS Assistance Inc (Drs Druckman and Quigley), Trevose, Pa; Dr Philip Harber, PLLC (Dr Harber), Tucson, Ariz; UCLA (Dr Harber), Los Angeles, Calif; and Department of Family Medicine (Dr Liu), David Geffen School of Medicine, UCLA, Los Angeles, Calif.

Address correspondence to: Robert L. Quigley, MD, DPhil, International SOS Assistance, Inc., 3600 Horizon Blvd., Suite 300, Trevose, PA 19053 ( or

Dr. Druckman and Dr. Quigley are employed by International SOS Assistance, Inc.

Copyright © 2012 by the American College of Occupational and Environmental Medicine