Introduction: Although gastroparesis is debilitating disease with high comorbidity burden, the data on the epidemiology of this disease is limited. We aim to determine rural vs urban differences in outcomes of hospitalized gastroparesis patients. Methods: We utilized the National Readmission Database (2010-2017) to study the outcomes of rural and urban populations in patients with history of gastroparesis. Associations of rural population with readmission and hospital resource utilization were computed in multivariable models adjusted for age, sex, presence of hypertension, diabetes, congestive heart failure, obesity, chronic kidney disease, pneumonia, HIV, alcohol use, smoking, disposition, teaching hospital status and insurance type. Results: During 2010 – 2017, 2,053,840 patients (mean age 52.8 ± 17.2, 65.3% females) with history of gastroparesis had indexed hospital admissions (Table). In all, 214,711 (10.5%) patients were residing in rural area. The diabetes mellitus was highly prevalent (69.7%) in gastroparesis population. Hypertension, chronic kidney disease, end stage renal disease, diabetic complications, HIV and history of malignancy were more common in urban population whereas coronary artery disease, chronic obstructive pulmonary disease were more prevalent in rural population. The 30-day readmission rates (HR: 0.89, 95% CI: 0.86-0.92), median cost ($22,634 IQR: 12,850,42,658 vs 31,394 17,443-59,734) (β: -13316, 95% CI -15264 to-11367) and median length of stay (4 days IQR: 2,6 vs 4 days IQR: 2,7 β: -0.97, 95% CI: -1.1 to -0.83) were lower in rural vs urban hospitalizations (Figure). The in-hospital mortality was similar in both groups. Diabetic ketoacidosis was the most common reason for 30-day readmission in rural population whereas diabetic neuropathy was the most common cause of readmission in urban group. The trends of 30-day readmission were improving in urban populations from 2010 to 2017. Conclusion: The hospitalized rural gastroparesis population has lower comorbidity burden as compared to urban population. The 30-day readmission rates, hospital cost and length of stay were much lower in the rural population.Figure 1.: A) Kaplan Meier curve showing 30 days readmission of hospitalized rural vs urban gastroparesis population. B) Trends of 30-day readmission of gastroparesis hospitalized patient from 2010 to 2017. Table 1. - Baseline characteristics of gastroparesis indexed admissions from 2010- 2017 Variables n=number of patients Total gastroparesis patients (n=2,384,095) Rural population (n =330,292) Urban population (n=2,053,840) P-value Age 53.0 ± 16.7 53.5 ± 16.5 52.9 ± 16.7 < 0.001 Female 1,556,551 (65.3) 214,711 (65.0) 1,341,840 (65.3) 0.27 Smoker 511,931 (21.5) 73,127 (22.1) 438,805 (21.4) 0.02 Alcohol 47,458 (2.0) 5,884 (1.8) 41,575 (2.0) < 0.001 Obesity 405,670 (17.0) 56,092 (17.0) 349,578 (17.0) 0.86 Hypertension 1,039,488 (62.4) 134,978 (60.9) 904,510 (62.6) < 0.001 Type 1 DM 411,749 (17.3) 59,162 (17.9) 352,587 (17.2) 0.005 Type 2 DM 1,248,767 (52.4) 175,134 (53) 1,073,634 (52.3) 0.03 Diabetic retinopathy 198,473 (8.3) 22,905 (6.9) 175,568 (8.6) < 0.001 Diabetic neuropathy 627,526 (26.3) 88,362 (26.8) 539,164 (26.3) 0.18 Diabetic nephropathy 259,042 (10.9) 32,852 (10.0) 226,190 (11.0) < 0.001 COPD 174,409 (7.3) 30,971 (9.4) 143,438 (7.0) < 0.001 Coronary artery disease 565,482 (23.7) 82,628 (25.0) 482,854 (23.5) < 0.001 Congestive heart failure 728,433 (30.6) 100,306 (30.4) 628,127 (30.6) 0.5 Chronic kidney disease 552,153 (23.2) 71,564 (21.7) 480,589 (23.4) < 0.001 ESRD 334,265 (14.0) 35,575 (10.8) 298,690 (14.5) < 0.001 Malnutrition 217,134 (9.1) 30,010 (9.1) 187,124 (9.1) 0.89 Pneumonia 163,785 (6.9) 26,115 (7.9) 137,670 (6.7) < 0.001 HIV 15,842 (0.7) 1,086 (0.3) 14,757 (0.7) < 0.001 History of malignancy 126,355 (5.3) 15,813 (4.8) 110,542 (5.4) < 0.001 Peptic ulcer disease 200,478 (8.4) 26,184 (7.9) 174,294 (8.5) 0.005 Nonvariceal upper GI bleeding 87,294 (3.7) 10.969 (3.3) 76,325 (3.7) < 0.001 Lower GI bleeding 86,666 (3.6) 11,792 (3.6) 74,873 (3.7) 0.34 Septic shock 36,783 (1.5) 4,540 (1.4) 32,244 (1.6) < 0.001 ICU admission 89,768 (3.8) 10,958 (3.3) 78,810 (3.8) < 0.001 Teaching hospital 1,366,346 (57.3) 79,730 (24.1) 1,286,616 (62.6) < 0.001 Insurance Medicare 1,270,059 (53.4) 187,504 (57) 1,082,555 (52.8) < 0.001 Medicaid 473,251 (19.9) 61,691 (18.7) 411,561 (20.1) Private 468,711 (19.7) 55,655 (16.9) 413,056 (20.1) Self-pay 94,936 (4.0) 14,816 (4.5) 80,120 (3.9) High Charlson comorbidity score 1,758,091 (73.7) 240,094 (72.7) 1,517,998 (73.9) < 0.001 Disposition Home 1,563,076 (65.6) 222,497 (67.4) 1,340,579 (65.3) < 0.001 Short term inpatient 18,135 (0.8) 4,402 (1.3) 13,732 (0.7) Transfer to SNF, ICF 317,217 (13.3) 43,663 (13.2) 273,554 (13.3) Home care 389,479 (16.3) 47,970 (14.5) 341,508 (16.6)