Abstract P362: Length Of Stay Discrepancies Between Rural And Urban Hospitals - A Cross Sectional Analysis Of Cardiovascular Disease Health Inequity

Abstract

Introduction: Rural communities have historically been shown to have greater obstacles to healthcare compared to their urban counterparts. These barriers manifest through multiple factors such as a reduced access to healthcare and public health services, lower availability of specialty care, and a larger number of uninsured. Compounded with a greater poverty rate, these disparities in minority populations have been shown to parallel their worse health outcomes and higher death rates. Our study aims to highlight cardiovascular disease health inequity between rural and urban populations through a cross-sectional analysis of the Length of Stay (LOS) with respect to cardiovascular disease admissions, specifically for unstable angina (UA), NSTEMI, and STEMI. Methods: This is a cross-sectional review for the LOS estimates in patients with cardiovascular disease in the state of New York, stratified by the type of community hospital. This review utilizes the 2020 National Inpatient Sample (NIS) for the state of New York. Cardiovascular disease was categorized using ICD-10 codes for STEMI (I21), NSTEMI (I21.4), and Unstable Angina (I20.0). Community hospital setting was categorized as either rural or urban, determined by the zip code of the primary inpatient hospital. Results: LOS was unique across both classification of cardiovascular disease ( p <0.001) and community hospital setting ( p <0.001). Overall, the LOS was less in urban-level community hospitals compared to their rural counterparts, 3.5 days vs 5.1 days ( p <0.001), as shown in Figure 1. Stratified by the cardiovascular disease classifications, admissions in rural hospitals had an overall increased LOS, 0.8 days for UA ( p <0.001), 1.4 days for NSTEMI ( p <0.001), and 2.7 days for STEMI ( p <0.001). Conclusion: The LOS of patients admitted for ACS was significantly higher across the board for rural hospitals. Furthermore, there was a stepwise increase in the comparative LOS between these two communities as the severity of their cardiovascular disease increased. Factors such as socioeconomic status, general access to healthcare and preventative services, insurance status, and availability of specialty care services are just some of the factors that contribute to rural health disparities.