Rural-urban differences in in-hospital mortality among admissions for end-stage liver disease in the United States.
Liver Transpl. 2019 Jun 17;:
Authors: Ross KH, Patzer RE, Goldberg D, Osborne NH, Lynch RJ
BACKGROUND: Access to quality hospital care is a persistent problem for rural patients. Little is known about rural-urban disparities in in-hospital outcomes for end-stage liver disease (ESLD) patients. We aimed to determine whether rural ESLD patients experienced higher in-hospital mortality than urban patients, and whether disparities were attributable to the rurality of the patient or the center.
METHODS: This was a retrospective study of admissions in the National Inpatient Sample, a population -based sample of hospitals in the United States. Admissions were included if they were from adult patients that had an ESLD-related admission defined from ICD-9 codes between January 2012 and December 2014. The primary exposures of interest were patient-level rurality and hospital-level rurality. The main outcome was in-hospital mortality. We stratified our analysis by disease severity score.
RESULTS: After accounting for patient- and hospital-level covariates, ESLD admissions to rural hospitals in every category of disease severity had significantly higher odds of in-hospital mortality than admissions to urban hospitals; those with moderate or major risk of dying had more than twice the odds of in-hospital mortality (OR for moderate: 2.41, 95% CI: 1.62, 3.59; OR for major: 2.49, 95% CI: 1.97, 3.14). There was no association between patient-level rurality and mortality in adjusted models.
CONCLUSIONS: ESLD patients admitted to rural hospitals had an increased odds of in-hospital mortality compared to those admitted to urban hospitals; differences were not attributable to patient-level rurality. Our results suggest that interventions to improve outcomes in this population should focus on the health systems level. This article is protected by copyright. All rights reserved.
PMID: 31206223 [PubMed - as supplied by publisher]