• Vol 9 • March 2007
Morbidity among Male Adolescents
In Israel, most adolescents are examined by a physician prior
to their conscription into the army. This nationwide medical ex-
amination is a potential source for assessing the state of health
of Israeli youth and for observing trends in the prevalence of
selected diseases over the years. Twenty years ago, Kark et al. 
published a study on the prevalence of selected diseases among
17 year old Israeli males examined in recruitment centers, and
compared their findings to cohorts of adolescents who had been
drafted in 1957–61 and 1977–78 . They concluded that the
prevalence of asthma and diabetes mellitus type 1 had increased
and that the prevalence of tuberculosis had decreased.
In the last 20 years a major demographic change occurred in
Israel due to massive immigration from Ethiopia and the former
Soviet Union . Also important is the significant progress in
diagnostic technology during this period. For example, 20 years
ago an echocardiogram was not part of the routine examination
for heart murmurs and diagnoses were largely based on physical
examination. Today most cardiac diagnoses are made by echo-
cardiogram, which may cause a bias in the reported prevalence
of heart defects. The aims of the present study were to examine
trends in the prevalence of common diseases in Israel in the
last 50 years and to examine whether ethnicity and immigration
influenced the prevalence of these diseases.
Subjects and Methods
The National Military Service Act requires all 17 year old Israelis
to present themselves at local recruitment centers for the
purpose of classification for military service. All Jewish, Druze
and Circassian males are obliged to serve in the military and
therefore undergo this physical examination. Arab citizens are
exempt from service, as are ultra-Orthodox Jews. Most boys
are examined (94% of those born in 1965–66 and 80% of those
born in 1986–87). Girls who declare themselves to be Orthodox
religious are exempted from service and are not examined. The
study was performed in males because of the relative complete-
ness of data.
The health examination includes a medical history uptake,
detailed physical examination and urinalysis. Documentation
of reported conditions is requested from the family physician.
Additional tests and referral to specialists are performed if
needed. Diagnosed conditions are categorized by diagnosis and
severity according to a standard classification manual.
The study group included all males who were examined in the
recruitment centers during 1992–94 and 2003–04. Comparisons
were made with reports on three similar cohorts in 1957–61,
1977–78 and 1982–84. Previous studies showed that the preva-
lence of diseases varies according to ethnic origin. We examined
the effect of origin on the prevalence of diseases by stratifying
the 2003–04 cohort according to the origin of the examinees. The
Background: Most Israeli males aged 16–17 undergo a thorough
medical examination prior to recruitment into the army. During
the last 50 years, extensive data have been gathered enabling
a study of time trends in the prevalence of common diseases in
this age group.
Objectives: To examine the current prevalence of common
diseases, compare the results with those of previous cohorts,
and assess the influence of the massive immigration during the
Methods: The health examination at the recruitment centers
includes a medical history, complete physical examination, and
review of medical documentation provided by the family physician.
If needed, additional tests and referral to specialists are ordered.
The prevalence of selected diseases and severity was drawn from
the computerized database of the classification board. Two cohorts,
1992–94 and 2003–04, were examined and compared with three
previous cohort studies in 1957–61, 1977–78 and 1982–84. Data
were stratified according to origin and country of birth.
Results: The prevalence of asthma increased dramatically during
the years from 10.2 per 1000 examinees in 1957–61 to 111.6 per
1000 examinees in 2003–04. The prevalence of tuberculosis declined
and then increased from 0.6 per 1000 adolescents in 1982–84 to
2.4 per 1000 adolescents in 2003–04. The prevalence of type 1
diabetes mellitus increased from 0.2 cases per 1000 examinees
in 1957–61 to 0.8 cases in 1977–78 and 1982–84 and 0.9 cases
per 1000 examinees in 2003–04. The prevalence of severe heart
defects and severe epilepsy declined in the last 20 years (1.4 and
1.7 cases per 1000 examinees in the 1982–84 cohort to 0.4 and
0.3 cases per 1000 examinees in the 2003–4 cohort respectively).
The patterns of disease prevalence were different for immigrants:
tuberculosis was more common while asthma and allergic rhinitis
were less prevalent.
Conclusions: The prevalence of common diseases among
adolescents in Israel has changed over the last 50 years. There is
a different pattern for immigrants and for those born in Israel.
Trends in Specific Morbidity Prevalence in Male Adolescents in Israel
over a 50 Year period and the Impact of Recent Immigration
Alon Farfel MD1, Manfred S. Green MD PhD2,3, Tzipora Shochat MsC1, Iris Noyman MD1, Yeheskel Levy MD1
and Arnon Afek MD1,3
1 Medical Corps, Israel Defense Forces, Israel
2 Israel Center of Disease Control, Tel Hashomer, Israel
3 Sackler Faculty of Medicine Tel Aviv University, Ramat Aviv, Israel
Key words: prevalence, asthma, tuberculosis, diabetes mellitus, Israel