Abstract 14620: Association of Rural Residence With In-Hospital Mortality for Heart Failure Hospitalizations in Texas: A Population-Based Cohort Study

Abstract

Background: Rural residents with heart failure may be at higher risk of mortality due to disparities in access to health care services. Patterns of urban-rural disparity in health care resources may vary across the United States and population level analyses of the impact of rural residence on hospitalized patients with heart failure in Texas are not conclusive. Hypothesis: Rural residence is associated with increased risk of in-hospital mortality in patients with heart failure. Methods: We used publicly available, statewide, and deidentified hospitalization records to study patients aged ≥18 years with heart failure as principal diagnosis in Texas for years 2016 through 2021. Three models estimated the association between rural residence and in-hospital mortality. Multilevel logistic regression with propensity adjustment was the primary analysis approach with propensity score matching and multivariable logistic regression without propensity score matching applied as alternative analyses. Additional analyses were completed for patient subgroups and for categories of heart failures. Results: Out of 460,798 heart failure hospitalizations (HFH), 61,480 (13.3%) were classified as rural residents. HFH with vs without rural residence were older (70.4% vs 64.8% aged ≥ 65years), more often white (63.5% vs 46.9%), less frequently had private insurance (26.2% vs 35.4%) and were less often admitted to teaching hospitals (19.5% vs 28.9%); p < 0.0001 for each. Unadjusted in-hospital mortality among HFH with and without rural residence was 2.5% vs 2.1%. On adjusted analyses, rural residence remained associated with higher odds of in-hospital mortality (adjusted odds ratio 1.1685 (95% CI [1.0878 - 1.2554]). The results were similar for the alternative modeling approaches, subgroup analyses, and categories of heart failures. Conclusions: Rural residence in Texas was associated with higher risk of in-hospital mortality in patients with heart failure.