- Approximately 520,000 residents (30 % Bedouins) inhabit the Negev region of southern Israel. Despite the geographical proximity, Bedouins differ from Jews demographically and socio-economically. To evaluate the ethnic disparities in emergency department (ED) utilization patterns in this population-based observational retrospective cohort study, individual data regarding 93,338 visits to the ED throughout 2007–2009 (9 months) were obtained. Demographic data were obtained from the Central Bureau of Statistics. The age- and gender-adjusted annual rates of ED visits were: 31.1 and 23 per 100 residents for Bedouins and Jews, respectively (P < 0.001). Significant differences in visiting patterns according to the weekday and time of day between these groups were observed. Bedouins were referred at a higher rate by a physician compared with Jews (81 vs. 61 %; P < 0.001). Ethnic disparities in chief complaints including the following age-adjusted odds ratio values of Bedouins compared with Jews were found: respiratory [Adj OR 1.38 (95 % CI 1.31–1.46)], fever [Adj OR 0.67 (95 % CI 0.64–0.71)], and cardiovascular [Adj OR 1.23 (95 % CI 1.16–1.32)] in Bedouins versus Jews, respectively (P < 0.001 each). Multivariate analysis demonstrated a higher risk for in-hospital admission among Bedouins than Jews [Adj OR 1.52 (95 % CI 1.47–1.58); P < 0.001]. Utilization patterns of EDs of Bedouins and Jews differ. Potential etiologies are increased morbidity, reduced accessibility to primary care clinics, use of private often non-board-certified physicians, and decreased socio-economic status among Bedouins. This warrants further research and interventional programs dealing with causes of the disparities.