Trends in Emergency Department utilization by disease categories in a migrant-dense high-income setting: a retrospective study in Dubai, 2021–2025

Abstract

Background

Global health systems are increasingly challenged by shifting patterns of communicable diseases, non-communicable diseases, and injuries. While these patterns have been widely studied in low- and middle-income settings, there is limited evidence describing how they manifest in emergency department utilization within high-income, migrant-dense contexts such as Dubai. This study aimed to examine temporal trends in emergency department utilization by disease categories and their demographic and clinical correlations in Dubai, UAE, from 2021 to 2025.

Methods

A retrospective observational study was conducted using electronic health records of 15,679 ED visits from January 2021 to June 2025 at the Emergency Department. Diagnoses were classified into communicable diseases, non-communicable diseases, injuries, and ill-defined conditions according to WHO ICD-10-CM guidelines. Descriptive statistics were used to summarize patient characteristics and disease burden. Temporal trends were assessed across study years. Multivariable Poisson regression models were applied to examine associations between demographic and clinical factors and emergency department utilization, with results reported as incidence rate ratios and 95% confidence intervals. A p-value ≤ 0.05 was considered statistically significant.

Results

NCDs increased by 44% (n = 1416), which included cardiovascular, digestive, and respiratory diseases. CDs have increased by 13% (n = 297), with respiratory infections being the most common, which peaked in 2023. Injuries increased by 66% (n = 324), especially among males and the younger age group. Ill-defined diseases declined by 26% (n=-1064), although they remained common in the older population. Compared to burden of disease in people aged 0 to 19 years, people aged 20–39 and 40–59 showed a higher relative risk of 8% and 9% [aRR: 1.08; 95%, CI: 1.08–1.09; aRR: 1.09, 95% CI: 1.08–1.09], while people aged 60–79 and over 80 reported a 12% and 16% higher likelihood, respectively [aRR: 1.12; 95%, CI: 1.11–1.14; aRR: 1.16, 95% CI: 1.13–1.19].

Conclusion

These findings highlight the need for integrated strategies linking emergency, primary, and preventive care, alongside policy measures focused on migrant health, occupational safety, and NCD prevention.

Introduction

Global healthcare systems are experiencing a shift in disease patterns characterized by the coexistence of communicable diseases (CDs), non-communicable diseases (NCDs), and injuries [1]. While infectious diseases remain a concern, NCDs now account for more than 74% of global mortality and are projected to exceed 77% by 2030, with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes contributing the majority of premature deaths [2, 3]. According to the World Health Organization (WHO) report of 2024, there are 4 major diseases, i.e., cardiovascular disease, cancer, chronic respiratory disease, and diabetes, which contribute the most to the NCD burden, causing 80% of premature deaths [2, 4]. Simultaneously, preventable injuries from road traffic accidents, occupational hazards, and interpersonal violence continue to strain the emergency care system [5, 6]. These overlapping conditions contribute to increasing demand for frontline services such as emergency departments [7]. In this context, analyzing emergency department utilization by disease categories over time can provide actionable insights into healthcare demand and service planning.

The interplay of these conditions is particularly critical in Emergency Departments (EDs), which act as the frontline of healthcare systems, providing acute care for urgent and preventable conditions simultaneously [8]. Global studies estimate that nearly half of all ED visits globally are attributed to NCDs and injuries [9, 10]. ED crowding, prolonged waiting times, and increased resource strain have been consistently linked with higher mortality rates, poor patient prognoses, and reduced healthcare efficiency [11].

In the Gulf region, rapid socioeconomic growth and migration have accelerated an epidemiological transition towards NCDs while infectious diseases and injury-related emergencies persist [12] yet road traffic injuries, occupational trauma, and infectious diseases remain significant contributors to emergency care demand. However, few studies have examined how these combined burdens manifest in ED utilization patterns in migrant-dense cities [12, 13].

Road traffic and occupational injuries continue to impose a substantial public health burden in the Gulf region. Despite some decline in fatalities since 1990, road injuries in the Middle East and North Africa (MENA) region continue to exceed global averages and remain a key driver of emergency care utilization. The highest age-standardized death rates are reported in Saudi Arabia, Oman, and the United Arab Emirates (UAE), reflecting rapid motorization, high-speed urban environments, and a large workforce engaged in physically demanding occupations [14, 15]. In parallel, communicable diseases such as tuberculosis, hepatitis B, and seasonal influenza remain persistent health concerns, particularly among expatriate labor populations whose mobility and varying access to preventive care contribute to periodic reintroduction of infections. This dual challenge of occupational injury and communicable disease transmission highlights the distinctive health risks facing migrant-majority settings like Dubai [16, 17].

Dubai presents a unique context, with over 85% of its population comprising expatriates from diverse backgrounds. This demographic structure creates distinct patterns of healthcare utilization. Despite advanced healthcare infrastructure, limited evidence exists on how these characteristics shape emergency department utilization across disease categories [18, 19]. Despite advanced health infrastructure and emergency response systems, there has been limited analysis of how these demographic and social dynamics shape patterns of emergency department utilization.

Globally and regionally, studies have described the rising dominance of NCDs and injury-related emergencies, yet few have contextualized these within high-income, migrant-dense environments [1, 20, 21]. Understanding how demographic and discharge characteristics intersect with disease categories in such a setting can reveal emerging gaps in acute and preventive care delivery [22, 23]. However, limited evidence exists on temporal trends and patterns of emergency department utilization by disease categories, particularly in migrant-dense, high-income settings, and on the demographic and clinical factors associated with these patterns. In this study, disease categories are used to describe patterns of emergency department presentations rather than formal burden-of-disease metrics such as disability-adjusted life years (DALYs), years of life lost (YLL), or years lived with disability (YLD).

Therefore, this study aims to analyze temporal trends in emergency department utilization by major disease categories (communicable diseases, non-communicable diseases, injuries, and ill-defined conditions) in a migrant-dense, high-income setting in Dubai from 2021 to 2025, and to examine associated demographic and clinical correlations of these utilization patterns.

Methods

Reporting guidelines

This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research. The reporting framework was used to ensure transparency in study design, data handling, and statistical analysis.

Study design and unit of analysis

This was a retrospective analytical study examining emergency department utilization patterns and temporal trends from January 2021 to June 2025. The unit of analysis was individual ED visits (encounters) rather than unique patients. This approach was adopted because the primary objective was to assess utilization patterns over time, including repeat visits. Where patients had multiple ED attendances during the study period, each visit was treated as a separate observation. In instances where more than one diagnosis was recorded per visit, only the primary discharge diagnosis coded using ICD-10-CM was used for classification to ensure mutually exclusive disease grouping.

Study setting

The study was conducted in the Emergency Department of King’s College Hospital London, Dubai, United Arab Emirates. The hospital is a 100-bed private tertiary care facility accredited by the Joint Commission International (JCI) and provides a range of specialized services including liver transplantation, orthopedics, and endoscopy.

Study population

The study included all patients who presented to the emergency department between January 2021 and June 2025. There were no restrictions based on age, gender, or nationality. All eligible ED visits during the study period were included in the analysis to ensure comprehensive representation of utilization patterns.

Data source and data management

Data were extracted from the hospital’s Electronic Health Records (EHR) system, which includes routinely collected clinical, demographic, and administrative information. The dataset comprised patient demographics, presenting complaints, ICD-10-CM coded diagnoses, discharge disposition, and length of stay. Data cleaning procedures included removal of duplicate entries and validation of inconsistencies. Missing data were assessed for all variables. Since missingness was minimal and did not exceed a significant threshold, a complete-case analysis approach was applied, and records with missing primary diagnosis or key outcome variables were excluded from analysis. All data were fully de-identified prior to analysis, and no direct patient identifiers (including names, identification numbers, or contact information) were accessed. Data were handled in compliance with institutional data protection policies to ensure confidentiality and privacy. Only aggregated data were used for analysis and reporting.

Disease classification

Primary diagnoses were coded using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Diagnoses were grouped into four mutually exclusive categories: communicable diseases, non-communicable diseases, injuries, and ill-defined conditions. Ill-defined conditions were defined as presentations characterized by non-specific symptoms, abnormal findings, or incomplete diagnostic information that did not permit assignment of a definitive ICD-10 diagnosis.

Study variables

The main variables included demographic characteristics such as age, gender, and nationality, as well as clinical variables including primary ICD-10 diagnosis, presenting complaint, discharge disposition, and length of stay. The outcome of interest was ED utilization, measured as the number of ED visits categorized by disease group over time.

Statistical analysis

Descriptive statistics were used to summarize patient characteristics and ED utilization patterns, with categorical variables presented as frequencies and percentages. Temporal trend analysis was performed to evaluate changes in ED visit distributions across disease categories over the study period. To assess associations between demographic and clinical variables and ED utilization patterns, a multivariable Poisson regression model was applied. Incidence rate ratios (IRRs) with 95% confidence intervals were reported. The choice of Poisson regression was based on the count nature of the outcome variable. Overdispersion was assessed using the ratio of deviance to degrees of freedom, and where present, robust standard errors were applied to account for variance inflation. An offset term representing total ED visits was included to adjust for differences in exposure over time. Model fit was evaluated using goodness-of-fit statistics, and multicollinearity among covariates was assessed using variance inflation factors, with no significant collinearity detected. All statistical tests were two-sided, and a p-value of ≤ 0.05 was considered statistically significant. Analyses were conducted using R-statistical software.

Results

ED utilization between 2021 and 2025 showed that NCDs consistently accounted for a higher proportion of total visits compared to CDs. Across the study period, communicable diseases increased from 2,281 cases in 2021 to 2,578 cases in 2025 (Δ13.02%), representing a modest change in their proportion of total ED visits. Within this category, respiratory infections constituted the majority of communicable disease presentations, accounting for 96.84% of CD-related ED visits. A temporal peak in respiratory infections was observed in 2023, followed by a decline in subsequent years. Non-communicable diseases demonstrated a larger increase in ED utilization, rising from 3,213 visits in 2021 to 4,629 in 2025 (Δ44.07%). As a proportion of total ED visits, NCDs remained the dominant category throughout the study period. The largest relative increases were observed in digestive diseases (122.69%), cardiovascular diseases (98.86%), and respiratory diseases (83.72%), while diabetes mellitus declined by 20.00%. Similar temporal patterns were observed across multiple categories, with peaks in 2023 followed by stabilization or decline. A total of 4,276 injury-related ED visits were recorded over the study period, increasing from 487 cases in 2021 to 811 in 2025 (Δ66.53%). Although injuries represented a smaller proportion of overall ED utilization compared to NCDs, they showed a consistent upward trend over time (Table 1; Fig. 1).

Table 1.

Emergency department visits by disease category and year (counts and percentage change), 2021–2025

Burden of Disease	2021	2022	2023	2024	2025	Δ%
Communicable	2281	4082	4910	4109	2578	13.02%
Infectious and parasitic diseases	66	80	133	140	70	6.06%
Respiratory infections	2212	4001	4776	3961	2442	10.40%
Other	3	1	1	8	66	2100.00%
Non-communicable	3213	4404	6640	6318	4629	44.07%
Cardiovascular diseases	88	85	108	201	175	98.86%
Congenital anomalies	1	2	2	2	1	0.00%
Diabetes mellitus	5	8	15	8	4	-20.00%
Digestive diseases	542	1066	1735	1733	1207	122.69%
Malignant neoplasms	4	3	4	5	6	50.00%
Respiratory diseases	215	421	817	682	395	83.72%
Other	2358	2819	3959	3687	2841	20.48%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
Injuries	487	612	1215	1151	811	66.53%

Fig. 1.

Trends Analysis of Burden of Disease in Emergency Department (2021–2025)

Age-stratified analysis showed that patients aged 0–39 years accounted for 79.77% of total ED visits. The proportion of NCD-related visits increased across younger age groups up to 39 years and declined in older populations. Patients aged over 60 years contributed only 2.21% of total ED visits. Communicable diseases and injuries were more frequently observed among younger age groups, particularly those aged 0–19 years, where communicable disease visits increased by 87.08% over time. In contrast, communicable diseases declined in older age groups, including 40–59 and 60–79 years. Injury-related visits were predominantly concentrated among individuals aged 0–39 years (86.11%) and were minimal among those aged over 60 years (Fig. 2).

Fig. 2.

Burden of disease of emergency cases by age (2021–2025)

Gender-based analysis showed comparable overall ED utilization between males and females. However, females demonstrated greater relative increases in both communicable diseases (20.24%) and non-communicable diseases (60.26%) compared to males (6.28% and 23.48%, respectively). Injury-related visits increased in both groups, with a higher proportion observed among males (Fig. 3). Regional analysis indicated that patients from Europe and Central Asia (37.49%) and the Middle East and North Africa (30.72%) accounted for the largest proportions of ED visits. Communicable disease visits increased notably among patients from Europe and Central Asia, while declining trends were observed in other regions. Non-communicable diseases increased across most regions, with the largest relative increases observed in East Asia and the Pacific, Europe and Central Asia, and South Asia (Table 2).

Fig. 3.

Burden of disease of emergency care cases by sex (2021–2025)

Table 2.

Emergency department visits by disease category stratified by demographic characteristics (counts and percentage change), 2021–2025

Burden of Disease	2021	2022	2023	2024	2025	Δ%
Communicable	2281	4082	4910	4109	2578	13.02%
0–19	658	1906	2505	2232	1231	87.08%
20–39	969	1425	1744	1346	938	-3.20%
40–59	630	719	630	505	392	-37.78%
60–79	22	29	29	24	14	-36.36%
80+	2	3	2	2	3	50.00%
Non-communicable	3213	4404	6640	6318	4629	44.07%
0–19	740	1305	2103	1800	1164	57.30%
20–39	1415	2020	3082	3144	2277	60.92%
40–59	953	984	1319	1246	1094	14.80%
60–79	92	88	116	110	79	-14.13%
80+	13	7	20	18	15	15.38%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
0–19	1872	2616	2569	1807	1335	-28.69%
20–39	1245	1257	2072	1596	1084	-12.93%
40–59	882	728	987	755	552	-37.41%
60–79	77	57	72	41	38	-50.65%
80+	5	6	13	6	8	60.00%
Injuries	487	612	1215	1151	811	66.53%
0–19	245	326	764	736	538	119.59%
20–39	147	178	288	282	178	21.09%
40–59	89	101	149	127	91	2.25%
60–79	6	6	14	5	4	-33.33%
80+	0	1	0	1	0	0.00%
Communicable	2281	4082	4910	4109	2578	13.02%
Female	1102	2054	2418	2063	1325	20.24%
Male	1179	2028	2492	2046	1253	6.28%
Non-communicable	3213	4404	6640	6318	4629	44.07%
Female	1799	2489	3697	3596	2883	60.26%
Male	1414	1915	2943	2722	1746	23.48%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
Female	2118	2399	2974	2253	1728	-18.41%
Male	1963	2265	2739	1952	1289	-34.34%
Injuries	487	612	1215	1151	811	66.53%
Female	209	266	551	520	368	76.08%
Male	278	346	664	631	443	59.35%
Communicable	2281	4082	4910	4109	2578	13.02%
East Asia and Pacific	194	330	336	266	163	-15.98%
Europe and Central Asia	706	1215	1600	1574	1038	47.03%
Latin America and Caribbean	65	101	119	113	78	20.00%
Middle East and North Africa	794	1453	1658	1256	729	-8.19%
North America	145	264	366	284	169	16.55%
South Asia	306	577	673	507	317	3.59%
Sub-Saharan Africa	71	142	158	109	84	18.31%
Non-communicable	3213	4404	6640	6318	4629	44.07%
East Asia and Pacific	180	242	429	376	278	54.44%
Europe and Central Asia	1151	1583	2433	2523	1901	65.16%
Latin America and Caribbean	83	109	177	147	117	40.96%
Middle East and North Africa	1091	1481	2090	1889	1266	16.04%
North America	210	255	392	386	256	21.90%
South Asia	385	581	884	828	656	70.39%
Sub-Saharan Africa	113	153	235	169	155	37.17%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
East Asia and Pacific	229	329	367	270	196	-14.41%
Europe and Central Asia	1420	1544	2157	1692	1294	-8.87%
Latin America and Caribbean	113	89	125	107	78	-30.97%
Middle East and North Africa	1362	1556	1705	1133	743	-45.45%
North America	302	323	377	261	195	-35.43%
South Asia	506	662	799	610	419	-17.19%
Sub-Saharan Africa	149	161	183	132	92	-38.26%
Injuries	487	612	1215	1151	811	66.53%
East Asia and Pacific	22	38	42	61	34	54.55%
Europe and Central Asia	234	268	570	573	435	85.90%
Latin America and Caribbean	11	16	32	23	25	127.27%
Middle East and North Africa	109	162	326	261	171	56.88%
North America	45	49	116	93	64	42.22%
South Asia	53	60	101	115	68	28.30%
Sub-Saharan Africa	13	19	28	25	14	7.69%

Regarding service outcomes, the majority of ED visits resulted in discharge with home approval (99.80%) (Table 3). The most common length of stay was 0–2 h (37.27%), followed by 3–5 h (30.48%). Longer durations (9–11 h and ≥ 12 h) showed increases over time, although they represented a small proportion of total visits (Table 3).

Table 3.

Emergency department visits by disease category stratified by discharge disposition (counts and percentage change), 2021–2025

Burden of Disease	2021	2022	2023	2024	2025	Δ%
Communicable	2281	4082	4910	4109	2578	13.02%
Discharged with approval - Home	2277	4075	4908	4109	2578	13.22%
Non-communicable	3213	4404	6640	6318	4629	44.07%
Discharged with approval - Home	3190	4389	6630	6312	4618	44.76%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
Discharged with approval - Home	4047	4649	5709	4203	3015	-25.50%
Injuries	487	612	1215	1151	811	66.53%
Discharged with approval - Home	487	611	1215	1151	811	66.53%
Communicable	2281	4082	4910	4109	2578	13.02%
LOS 0–2 h	1140	1657	1907	1409	1236	8.42%
LOS 3–5 h	672	1032	1428	1171	648	-3.57%
LOS 6–8 h	286	640	827	639	289	1.05%
LOS 9–11 h	100	396	457	423	230	130.00%
LOS 12 + hours	83	357	291	467	175	110.84%
Non-communicable	3213	4404	6640	6318	4629	44.07%
LOS 0–2 h	1463	1605	2145	1878	1911	30.62%
LOS 3–5 h	1192	1308	2117	2043	1395	17.03%
LOS 6–8 h	367	685	1208	1026	527	43.60%
LOS 9–11 h	127	442	686	668	408	221.26%
LOS 12 + hours	64	364	484	703	388	506.25%
Ill-defined	4081	4664	5713	4205	3017	-26.07%
LOS 0–2 h	1775	1650	1782	1132	1242	-30.03%
LOS 3–5 h	1534	1372	1900	1345	866	-43.55%
LOS 6–8 h	476	783	1036	752	374	-21.43%
LOS 9–11 h	194	467	595	432	261	34.54%
LOS 12 + hours	102	392	400	544	274	168.63%
Injuries	487	612	1215	1151	811	66.53%
LOS0-2 h	260	274	446	398	450	73.08%
LOS 3–5 h	142	148	317	306	135	-4.93%
LOS 6–8 h	58	88	217	184	99	70.69%
LOS 9–11 h	20	57	143	124	71	255.00%
LOS 12 + hours	7	45	92	139	56	700.00%

Compared to burden of disease in people aged 0 to 19 years, people aged 20–39 and 40–59 showed a higher relative risk of 8% and 9% [aRR: 1.08; 95%, CI: 1.08–1.09; aRR: 1.09, 95% CI: 1.08–1.09], while people aged 60–79 and over 80 reported a 12% and 16% higher likelihood, respectively [aRR: 1.12; 95%, CI: 1.11–1.14; aRR: 1.16, 95% CI: 1.13–1.19]. Male emergency cases had a reduced risk ratio by 2% after adjustment [aRR: 0.98; 95% CI: 0.97–0.98], which remained significant (Table 4).

Table 4.

Crude relative risk (cRR) and adjusted relative risk (aRR) using poisson regression of burden of disease in emergency department (2021-2025)

Characteristics	cRR (95% CI)	p-value	aRR (95% CI)	p-value
AGE_GROUP: 0-19 (ref)	1.00	-	1.00	-
AGE_GROUP: 20-39	1.09 (1.09 - 1.10)	0.00	1.08 (1.08 - 1.09)	0.00
AGE_GROUP: 40-59	1.09 (1.08 - 1.10)	0.00	1.09 (1.08 - 1.09)	0.00
AGE_GROUP: 60-79	1.13 (1.11 - 1.14)	0.00	1.12 (1.11 - 1.14)	0.00
AGE_GROUP: 80+	1.16 (1.13 - 1.19)	0.00	1.16 (1.13 - 1.19)	0.00
SEX: Female (ref)	1.00	-	1.00	-
SEX: Male	0.97 (0.96 - 0.97)	0.00	0.98 (0.97 - 0.98)	0.00
Region: East Asia and Pacific (ref)	1.00	-	1.00	-
Region: Europe and Central Asia	0.99 (0.98 - 0.99)	0.00	0.99 (0.99 - 1.00)	0.07
Region: Latin America and Caribbean	0.99 (0.98 - 1.01)	0.31	0.99 (0.98 - 1.01)	0.30
Region: Middle East and North Africa	1.00 (1.00 - 1.01)	0.25	1.00 (0.99 - 1.01)	0.83
Region: North America	0.97 (0.96 - 0.98)	0.00	0.99 (0.98 - 1.00)	0.02
Region: South Asia	1.01 (1.00 - 1.02)	0.01	1.01 (1.00 - 1.02)	0.01
Region: Sub-Saharan Africa	1.01 (1.00 - 1.02)	0.04	1.01 (1.00 - 1.02)	0.07
DISCHARGE_DISPOSITION: Administrative discharge (ref)	1.00	-	1.00	-
DISCHARGE_DISPOSITION: Deceased	1.05 (0.99 - 1.11)	0.09	1.06 (0.99 - 1.13)	0.09
DISCHARGE_DISPOSITION: Discharge transfer to acute care	0.92 (0.84 - 1.01)	0.09	0.96 (0.87 - 1.05)	0.35
DISCHARGE_DISPOSITION: Discharge transfer to non-acute care	0.98 (0.91 - 1.05)	0.55	1.01 (0.94 - 1.09)	0.73
DISCHARGE_DISPOSITION: Discharged absent without leave	0.98 (0.87 - 1.10)	0.68	0.98 (0.87 - 1.10)	0.74
DISCHARGE_DISPOSITION: Discharged against advice	0.94 (0.89 - 1.00)	0.05	0.95 (0.89 - 1.01)	0.10
DISCHARGE_DISPOSITION: Discharged with approval - Home	0.87 (0.82 - 0.92)	0.00	0.90 (0.84 - 0.96)	0.00
DISCHARGE_DISPOSITION: Not discharged	0.86 (0.71 - 1.03)	0.10	0.87 (0.74 - 1.04)	0.12
LOS_GROUP: 1-2 (ref)	1.00	-	1.00	-
LOS_GROUP: 3-5	1.03 (1.03 - 1.04)	0.00	1.02 (1.02 - 1.02)	0.00
LOS_GROUP: 6-8	1.02 (1.01 - 1.02)	0.00	1.01 (1.00 - 1.01)	0.03
LOS_GROUP: 9-11	1.01 (1.01 - 1.02)	0.00	1.01 (1.00 - 1.01)	0.07
LOS_GROUP: 12+	1.02 (1.01 - 1.02)	0.00	1.01 (1.00 - 1.01)	0.06

CI- Confidence Interval

Discussion

This study provides one of the first comprehensive applications of the burden of disease framework to emergency department utilization in Dubai, analyzing five-year data across CDs, NCDs, injuries, and ill-defined diseases. The findings may reflect global and regional epidemiological transitions while also highlighting Dubai’s distinctive demographic composition as a high-income, migrant-majority city.

The results of this study show a 44% increase in NCD cases, with cardiovascular, digestive, and respiratory conditions being the most common. Similar patterns have been observed in other migrant-rich cities such as Qatar and Singapore, where urban lifestyle, sedentary behavior and dietary changes have been associated with a comparable rise in NCD-related emergency visits. These studies similarly note that while NCD prevalence often increases with income, utilization patterns differ among migrant subgroups depending on occupational exposures and access to primary care [24, 25]. The findings from previous studies done in the UAE also reflect this complexity, where there is a high NCD burden among a diverse expatriate population of working-age individuals from skilled professionals to manual laborers each with their own risk profiles based on their jobs, insurance coverage and health-seeking behavior [26–28].

The twofold rise in cardiovascular-related ED visits echoes findings from Qatar, Saudi Arabia and Singapore where metabolic syndrome, hypertension and obesity are increasingly seen among both high-income and middle-income migrant groups [24, 25, 29].

The sharp increase in digestive disorders may be associated with dietary and psychosocial factors reported in similar populations common to urban expatriates may be associated with higher intake of processed food, stress and irregular eating pattern [30, 31]. These findings are consistent with studies from Sri Lanka, Saudi Arabia and South Korea linking gastro-esophageal reflux (GERD) and functional bowel diseases to occupational stress and long working hours [30, 32, 33].

Similarly, the rise in respiratory NCDs corresponds with studies from Kuwait and South Korea, where environmental pollutants, dust exposure and indoor air quality have been linked in prior studies to environmental exposures asthma and Chronic Obstructive Pulmonary Disease (COPD) exacerbations, particularly among industrial and service workers [34, 35].

The observed 20% decline in diabetes-related ED visits may reflect changes in patterns of healthcare utilization or management reported in previous studies, consistent with health system improvements documented in studies from UAE, Australia and the United States, where integrated chronic disease programs have reduced ED reliance [36–38]. However, it has been associated in previous studies with differences in healthcare access among migrant populations, a disparity highlighted in studies from Malaysia and China, where structural and financial barriers restricted migrants access to non-emergency care [39, 40]. Similar findings were reported in a systematic review where the authors analyzed emergency department utilization across several high-income and middle-income countries including Italy, Germany, Sweden, Canada and Australia, where they found that migrants often face restricted access to primary care and rely disproportionately on ED services for both urgent and non-urgent needs [41]. This dual pattern reinforces that both high-income and low-income migrant groups contribute to emergency demand, although for different reasons highlighting the importance of differentiated prevention and care strategies [42].

Communicable diseases increased by 13%, mainly respiratory infections with a distinct peak in 2023. his pattern is consistent with international surveillance trends international surveillance trends, including data from the Europeans Centre for Disease Prevention and Control (ECDC), which reported a substantial rise in respiratory infections particularly influenza, respiratory syncytial virus (RSV) and SARS-coV-2 across the European Union (EU) and European Economic Area (EEA) [43, 44].

The concentration of these cases was observed to be higher among the younger age groups (0–19 years), and migrants from Europe and Central Asia may be influenced by differences in exposure patterns and immunization histories. Similar findings from the United Kingdom and Canada also showed that vaccination gaps and delayed access to primary care increase reliance on ED for acute infections, highlighting the need for cross-border immunization coordination and migrant-friendly surveillance programs [45, 46].

The 66% increase in injury-related visits, particularly among males aged 0–39 years. This pattern corresponds with studies from the United Kingdom, Turkey, Saudi Arabia, and Oman, where occupational injuries and road traffic accidents remain leading causes of emergency visits among working-age men [47–50]. In Dubai, where a large proportion of the workforce is employed in construction, logistics, and service sectors, similar patterns have been reported in previous UAE-based research identifying occupational trauma and musculoskeletal injuries as major contributors to ED caseload [51, 52]. Although national safety initiatives have improved outcomes, injury rates in the Gulf region remain higher than other high-income regions such as Western Europe [53]. Strengthened enforcement of workplace safety standards, occupational health surveillance and culturally tailored injury prevention programs remain essential [54, 55].

The 26% decline in ill-defined diseases may be associated with improvements in diagnostic practices reported in other settings and coding practices, with improvements observed in both high-income settings like the United States and lower-resource contexts such as Nigeria, where ICD-10-driven systems were implemented [56, 57]. Nevertheless, their persistence among older adults suggests continued diagnostic uncertainty in complex acute presentations, a challenge also noted in geriatric emergency studies worldwide [58, 59].

Age and gender trends further distinguish Dubai’s ED Landscape. Nearly 80% of ED visits were made by patients under 40 years old, contrasting with aging populations in Western countries where ED utilization peaks in the elderly [60]. This younger and economically active demographic was also observed in studies from Germany, Malaysia, and Saudi Arabia, highlighting how age distribution among immigrant populations can shape patterns of emergency care utilization and the types of condition managed in acute settings [61–63]. The age profile has implications for health planning, where preventive programs should target road traffic safety, occupational risk reduction and lifestyle interventions for NCD risk factors among younger immigrants [64].

Gender disparities were also evident where females presented with higher cases of NCD and illness-defined disease, whereas injuries were reportedly more common among males. These differences may reflect variations in health-seeking behavior, where women are more likely to seek medical care for chronic and non-specific conditions and men are more likely to experience high-risk exposures leading to injury [65, 66]. Similar patterns have been observed in studies from South and East Asia, where gendered occupational and cultural roles shape health outcomes [67, 68].

Furthermore, the increasing length of stay (LOS) in our data (≥ 9 h) reflects a universal challenge of ED crowding, linked to delayed admissions, insufficient inpatient capacity, and rising complexity of cases [69]. In Dubai, prolonged ED stays prolonged ED stays have been associated in previous studies with system-level factors such as bed availability and care coordination in a diverse patient population [69, 70].

It has been estimated that emergency conditions account for more than half of all deaths worldwide with a higher impact reported in LMICs [71]. Although this study focuses on Dubai, its implications extend to EDs worldwide serving multicultural or migrant-heavy populations. As global migration continues to reshape urban health systems, lessons from Dubai’s evolving ED patterns can guide preparedness in other high-income yet demographically complex regions.

Strengths and limitations

The key strength of this study is its application of the BOD framework to a large, five-year dataset in a high-income, migrant-majority context, which is an underexplored intersection in emergency medicine research. The use of ICD-10 coding ensures comparability with global studies. Furthermore, examining demographic and discharge variables allows for a refined understanding of ED utilization.

This study has several limitations that should be considered when interpreting the findings. First, the study was conducted in a single private tertiary care hospital, which may introduce selection bias and limit generalizability. The patient population in this setting may not fully represent the broader population of Dubai or the UAE, particularly lower-income, uninsured, or labor-sector groups who may preferentially access public healthcare facilities. Second, the use of routinely collected EHR data may be subject to coding inaccuracies, missing data, and potential misclassification of diagnoses based on ICD-10 coding. Although data cleaning procedures were applied, the possibility of residual errors cannot be excluded. Third, the study lacked key socioeconomic and occupational variables, such as income level, employment type, and insurance status, which are important determinants of healthcare utilization, particularly in migrant populations. The absence of these variables limits the ability to explore underlying drivers of observed utilization patterns. Fourth, the analysis was based on facility-level ED visit data and did not include population-level denominators. As a result, findings reflect patterns of emergency department utilization rather than population-based incidence or prevalence rates.

Finally, the retrospective observational design precludes causal inference. The associations observed should be interpreted as descriptive utilization patterns rather than indicative of causal relationships. Future multi-center studies incorporating socioeconomic, occupational, and population-level data are needed to provide a more comprehensive understanding of emergency care utilization in diverse and migrant-dense settings.

Recommendations and future directions

This study reinforces that migration is not a singular health determinant but a spectrum of experiences influencing disease risk, service access, and emergency utilization [72]. Dubai’s findings parallel those from other globalized urban centers such as Singapore, Toronto, London and Sydney, where demographic diversity and mobility reshape ED demand [73, 74]. For emergency medicine, this highlights the need for a flexible care model, culturally sensitive communication and data systems that account for mobility and social determinants. Strengthening the interface between emergencies, primary and occupational health services will be vital for managing the evolving burden of disease in cities shaped by migration and globalization [75, 76].

Moreover, the rise in NCD-related ED visits highlights the need for stronger prevention and early detection strategies, which include community-based screening for hypertension, diabetes, and cardiovascular risk factors [77]. Injury prevention must remain a priority with stricter enforcement of road safety laws and improved occupational safety standards for migrant workers [78]. For communicable diseases, robust surveillance systems are critical to detect seasonal and pandemic-related fluctuations [79].

At the system level, rising ED length of stay signals the need for enhanced triage protocols, observation units and improved coordination between emergency, inpatient and outpatient services [80]. Integration of ED data into Dubai’s broader health information systems could enable real-time monitoring of morbidity trends and support evidence-based resource allocation.

Conclusion

In conclusion, this study describes temporal trends in emergency department utilization by disease categories in a private tertiary care setting in Dubai. Non-communicable diseases accounted for the largest proportion of ED visits over the study period, with increases also observed in communicable diseases and injury-related presentations. These patterns were most prominent among younger, working-age populations. The findings provide insight into ED utilization patterns within a migrant-dense, high-income urban setting. However, given the single-center design and absence of population-level data, the results should be interpreted with caution and may not be generalizable to all healthcare settings in Dubai or the wider region.

Abbreviations

BOD

Burden of disease

CDs

Communicable Diseases

COPD

Chronic Obstructive Pulmonary Disease

DALY

Disability-Adjusted Life Year

ECDC

Europeans Centre for Disease Prevention and Control

ED

Emergency Department

EEA

European Economic Area

EHR

Electronic Health Records

EU

European Union European Economic Area (EEA)

GERD

Gastro-Esophageal Reflux Disease

ICD-10

International Classification of Disease, 10th Revision, Clinical Modification

JCI

Joint Commission International

LOS

Length of Stay

NCDs

Non-Communicable Diseases

RSV

Respiratory Syncytial Virus

UAE

United Arab Emirates

WHO

World Health Organization

Author contributions

SS, LS- Conceptualization, methodology, data curation, data analysis, writing reviewing and editing original draft and final draft. SI- writing reviewing and editing original draft. LA- data analysis, writing reviewing and editing original draft. TA- Supervision. All authors approved the final version of the manuscript.

Funding

No funding.

Data availability

Available on reasonable request to the corresponding author.

Declarations

Ethical approval and consent to participate

The research was carried using the “Declaration of Helsinki.” Ethics approval was taken from the “Ethics Review Committee of King’s College Hospital London, Dubai, UAE” (KCH-REC-2025-073). As this was a retrospective study using routinely collected data, the requirement for informed consent was waived by the ethics committee in accordance with applicable guidelines for minimal-risk research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.