Rural-Urban Disparities in Inpatient Outcomes for Opioid Overdose: A Nationwide Analysis.

Abstract

Objectives: Substantial gaps in clinical outcomes exist in rural and urban hospitals in the United States. Our findings highlight the impact of geographic location on hospital care, guiding targeted interventions to improve opioid-related outcomes in rural and urban areas.

Methods: We used the National Inpatient Sample to examine trends in hospitalizations, in-hospital mortality, length of stay, and inflation-adjusted cost of adults admitted for an opioid overdose between 2016 and 2021.

Results: Between 2016 and 2021, age-adjusted hospitalizations consistently declined across urban, rural, and overall populations. Urban hospitalization rates decreased from 700 to 500 per 100 000, while rural rates fell from 150 to under 100 per 100 000. Strong negative correlations indicated significant downward trends in hospitalizations across all groups (urban and total: τ = -0.99, P = .008; rural: τ = -0.99, P = .009). Rural patients had higher odds of in-hospital mortality (OR [95% CI]: 1.24 [1.1-1.4], P < .001), requiring invasive mechanical ventilation (OR [95% CI]: 1.46 [1.37-1.56], P < .001), and hemodialysis (OR [95% CI]: 1.64 [1.42-1.89], P < .001), with similar findings in propensity-matched cohorts. Additionally, rural patients were more likely to develop venous thromboembolism (VTE) (OR [95% CI]: 1.20 [1.00-1.43], P = .045), anoxic brain damage (OR [95% CI]: 1.15 [1.02-1.30], P = .025), and acute liver failure (OR [95% CI]: 1.34 [1.18-1.53], P < .001), although VTE did not reach significance in matched cohorts (P = .120). Rural hospitalizations incurred lower inflation-adjusted costs by $1367.89 (P < .001) and had a shorter adjusted length of stay by 0.49 days (P < .001) compared to urban settings.

Conclusion: In conclusion, significant disparities in outcomes for opioid overdose patients highlight challenges in rural health care, including higher in-hospital mortality and complications. Continued healthcare policy reforms are warranted to alleviate the disparities in rural-urban cardiovascular outcomes.