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Rural‐Urban Differences in In‐Hospital Mortality Among Admissions for End‐Stage Liver Disease in the United States
Author(s) -
Ross Katherine H.,
Patzer Rachel E.,
Goldberg David,
Osborne Nicolas H.,
Lynch Raymond J.
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25587
Subject(s) - medicine , rurality , odds ratio , confidence interval , odds , emergency medicine , retrospective cohort study , population , rural area , demography , environmental health , logistic regression , pathology , sociology
Access to quality hospital care is a persistent problem for rural patients. Little is known about disparities between rural and urban populations regarding 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. This was a retrospective study of patient 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 who had an ESLD‐related admission defined by codes from the International Classification of Diseases, Ninth Revision, 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. 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 patient admissions to urban hospitals. Those with moderate or major risk of dying had more than twice the odds of in‐hospital mortality (odds ratio [OR] for moderate risk, 2.41; 95% confidence interval [CI], 1.62‐3.59; OR for major risk, 2.49; 95% CI, 1.97‐3.14). There was no association between patient‐level rurality and mortality in the adjusted models. In conclusion, ESLD patients admitted to rural hospitals had increased odds of in‐hospital mortality compared with those admitted to urban hospitals, and the differences were not attributable to patient‐level rurality. Our results suggest that interventions to improve outcomes in this population should focus on the level of the health system.