S2703 A Comparative Analysis of Rural and Urban Disparities in Alcoholic Hepatitis Outcomes: Insights From the National Inpatient Sample Database

Introduction: Alcoholic hepatitis is a severe inflammatory liver condition with high mortality, especially in severe cases. While the pathophysiology and management of alcoholic hepatitis have been studied extensively, rural-urban disparities in outcomes remain underexplored. Rural populations often face challenges such as delayed diagnosis and limited access to specialized care. This study examines rural-urban differences in outcomes of alcoholic hepatitis, including mortality, acute kidney injury, mechanical ventilation needs, length of stay, and hospitalization costs. Methods: This retrospective cohort study utilized the National Inpatient Sample (NIS) database from 2016 to 2021, analyzing 145,770 adult patients diagnosed with alcoholic hepatitis, stratified by rural (n = 17,790) and urban (n = 127,980) residence. Propensity score matching was performed to create a balanced subset (n = 35,580). Multivariable logistic and linear regression models adjusted for demographic, clinical, and hospital-level variables were employed to evaluate in hospital outcomes, including mortality, complications (acute kidney injury, mechanical ventilation), length of stay, and costs. Results: Rural patients exhibited significantly higher in-hospital mortality (2.81% vs 2.39%; aOR 1.47, 95% CI 1.05–2.04, P = 0.023) and complications such as acute kidney injury (18.27% vs 11.78%; aOR 2.04, P < 0.001) and mechanical ventilation (3.15% vs 2.53%; aOR 1.67, P = 0.001). Rural patients also experienced longer length of stay (5.72 vs 5.19 days, P < 0.001) and higher adjusted hospitalization costs (mean $10,548 more, P < 0.001). Conclusion: Rural patients hospitalized with alcoholic hepatitis experience worse outcomes than urban patients, highlighting systemic disparities in care delivery. Strengthening inpatient resources and standardizing management protocols may help reduce these inequities.