S2659 A Comparative Analysis of Rural and Urban Disparities in Alcohol-Associated Cirrhosis Outcomes: Insights From the National Inpatient Sample Database

Introduction: Rural-urban disparities in outcomes among patients with alcohol-associated liver disease (ALD) remain understudied at the national level. This study evaluated differences in inpatient outcomes, complications, and healthcare utilization among hospitalized adults with alcoholic cirrhosis across rural and urban populations in the United States. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016–2021), identifying adult hospitalizations with a primary diagnosis of alcoholic cirrhosis using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rural-urban status was determined using patient residence data. Multivariable logistic and linear regression models were used to compare in-hospital mortality, complications, length of stay (LOS), and total hospitalization costs, adjusting for demographic, hospital-level, and clinical covariates. Results: Among 422,670 hospitalizations for alcoholic cirrhosis, 13.2% were from rural areas. Rural patients were more likely to be older (mean age: 53.9 vs 52.3 years), White (79.1% vs 64.3%), from lower-income zip codes (household income ≤$51,999: 56.6% vs 30.0%), and have higher rates of smoking (56.7% vs 52.3%) and obesity (14.3% vs 12.6%) compared to urban patients. In-hospital mortality was significantly higher in rural patients (5.9% vs 4.7%; adjusted odds ratio [aOR] 1.23, 95% CI: 1.12–1.34, P < 0.001). Rural patients also had increased odds of spontaneous bacterial peritonitis (aOR 1.19, 95% CI: 1.08–1.30) and variceal bleeding (aOR 1.18, 95% CI: 1.12–1.24). No significant differences were found in LOS or use of mechanical ventilation. Total hospitalization costs were significantly lower in rural patients ($64,690 vs $82,236; P < 0.001). Conclusion: Rural patients hospitalized with alcoholic cirrhosis face higher risks of inpatient mortality and complications despite similar lengths of stay and lower hospitalization costs. These findings highlight persistent geographic disparities in cirrhosis care and underscore the need for targeted clinical and policy interventions in rural health systems. By leveraging a large, nationally representative dataset, this study adds important evidence on how rural residence is associated with worse inpatient outcomes in alcohol-associated liver disease, supporting the need for more equitable resource allocation and care models in hepatology.