Rural-Urban Disparities in Heart Failure and Liver Cirrhosis Hospitalizations: A National Inpatient Sample Database Analysis (2016-2022).

Abstract

Heart failure and cirrhosis interplay predisposes patients to increased inpatient morbidity, acute decompensation, renal injury, infection, procedural complications, prolonged hospitalizations, and healthcare costs. In this retrospective observational study, we analyzed data from the Nationwide Inpatient Sample spanning 2016 to 2022 to assess rural-urban disparities and temporal trends in adult patients hospitalized with concurrent HF and liver cirrhosis in the U.S. Validated International Classification of Diseases, 10th Revision codes were used to identify these patients. A total of 498,539 hospitalizations (weighted >2.49 million) met inclusion criteria, of which 14.9% occurred in non-metropolitan hospitals and 85.1% in metropolitan hospitals. In-hospital mortality was higher in rural settings (8.0% vs. 7.3%), with slightly longer hospital stays in urban settings that incurred a greater financial burden, with higher inflation-adjusted costs ($24,026 vs. $20,948). These results were consistent with propensity-matching. The study concludes that strategies to improve regional healthcare access and equity in complex multisystem disease management are needed.