Hospital AI and robotics adoption and access inequality in the United States

Abstract Hospital artificial intelligence (AI) and robotics are diffusing unevenly across the United States, but national evidence on adoption, access, and 2023 care outcomes remains limited. We linked calendar-year 2023 American Hospital Association adoption data for 6166 hospitals with 2023 CMS hospital outcomes, 2023 CDC hospital-setting mortality, and county social and population data for 3143 U.S. counties. Access inequality was substantial: 65.8% of the access-analysis population lived within 30 minutes of AI-enabled care, and population-weighted travel burden remained highly unequal for AI and robotics access (Gini = 0.740 and 0.776) despite a 56% increase in AI-enabled hospitals between 2022 and 2024. In adjusted models conditioning on 2019 baseline performance and organizational and county covariates, staff-scheduling AI was associated with higher sepsis bundle completion (3.9% relative difference), and routine-task automation AI with lower 30-day pneumonia mortality (5.4%). County-level mortality associations were more heterogeneous: access to routine-task automation AI was associated with lower 2023 hospital-setting mortality in the primary specification, but the estimate was sensitive to estimator choice and organizational-capacity adjustment. These findings benchmark AI- and robotics-enabled hospital access inequality and suggest outcome-specific adjusted associations warranting longitudinal confirmation rather than causal interpretation.