Rural-Dwelling Patients With Rheumatoid Arthritis and Risk of Myocardial Infarction Hospitalization: An Observational Study Using the National Inpatient Sample.

Abstract

Objective: To assess whether there is a rural-urban and income-related disparity in the incidence and outcomes of hospitalization for myocardial infarction (MI) in patients with rheumatoid arthritis (RA).

Methods: We used the 2016-2019 US National Inpatient Sample (NIS) data and selected all patients with RA. Rural vs urban residential status was identified using NIS classifications. We categorized median household income based on patient ZIP code by quartile. We assessed the multivariable-adjusted odds ratios (aORs) to examine the association of rural residence with MI hospitalization.

Results: The crude rate of MI hospitalization per 100,000 area-specific hospitalizations in people with RA was significantly higher for rural vs urban residents, 2441 vs 1878 (P < 0.001). In multivariable-adjusted models, compared to urban residents, rural-residing residents with RA were almost twice as likely to be hospitalized with MI (aOR 1.70; P < 0.001). Rural residence was not significantly associated with higher hospital charges or MI hospitalization costs (P > 0.05). Compared to the lowest quartile, the 2 highest income quartiles were significantly associated with lower odds of MI hospitalization in patients with RA; aORs were 0.87 (P < 0.001) and 0.92 (P = 0.01). Female sex, African American race, elective admission, Medicare payer, government hospital ownership, rural hospital location, and small hospital bed size were significantly associated with lower odds of MI hospitalization.

Conclusion: Our study findings of rural-urban and socioeconomic status disparities for MI hospitalizations in patients with RA provide policymakers with data and information for action. Policy decisions based on these data can potentially reduce these disparities and improve outcomes for rural residents.