Ok so pretty much X 50 ppl

Y has 100 ppl

X 1 person hospitalized

Y has 4 ppl hospitalized

So initially I thought this doesn't really seem like a paradox but wtv, lets just explain why Y has more hospital patients.

A. Ok if preventive health programs are more common X than in Y that'll explain why Y has more people in hospitals.

B. (I was between this and D just because I couldn't eliminate D) This actually explains the phenomena though. If city X is a leader in outpatient treatment whenever possible that explains why they have less hospitalizations they just send everyone home.

C. Perfect the drinking water of Y has DANGEROUSLY high toxins compared to that of X so that could cause more people to be sick and end up in hospitals

D*: (Read carefully) The hospitals in Y are of high quality and X ppl are sent there for treatment. Ok just because X people are sent there let's say to get the pain medication that wouldn't explain why Y has more hospital patients. They could just go get the medication and leave.

E. Fair assumption to make that if stress is correlated with higher hospitalizations