A105-11 Urban vs Rural Hospitalization Rates and Mortality for Tuberculosis in the United States

Abstract Introduction/Rationale Tuberculosis (TB) remains a public health concern in the United States, with regional and institutional disparities. Urban teaching hospitals are often referral centers for complex and extrapulmonary cases, whereas rural and community facilities face challenges in early detection and specialized care. Understanding variations in TB hospitalizations and mortality across hospital settings can help identify structural gaps and improve disease management. Methods We conducted a cross-sectional study using data from the National Inpatient Sample (NIS) from 2018 to 2021. Adult patients (≥18 years) with a primary diagnosis of tuberculosis (ICD-10 codes A15-A19) were identified. Hospitals were categorized by location and teaching status into three groups: rural, urban non-teaching, and urban teaching. Clinical outcomes analyzed were in-hospital mortality and length of stay (LOS). Associations between hospital type, TB subtype, mortality, and LOS were evaluated using the Chi-square test, with statistical significance defined as p 0.05. All analyses were performed using IB; SPSS Statistics version 25.0 Results A total of 1,624 TB-related hospitalizations were identified, of which 1,020 cases (62.8%) occurred in urban teaching hospitals, 410 (25.2%) in urban non-teaching hospitals, and 194 (11.9%) in rural hospitals. The association between hospital type and in-hospital mortality was statistically significant (p 0.016). Urban teaching hospitals accounted for the highest number of TB admissions. Still, they reported a lower in-hospital mortality rate (4.2%) compared with urban non-teaching hospitals (6.8%) and rural hospitals (7.4%). No significant differences were observed across TB subtypes. The length of stay varied significantly across hospital types, with more extended hospitalizations observed in patients with miliary (p = 0.002) and extrapulmonary TB (p = 0.031) treated at urban teaching centers. Discussion The national analysis reveals that tuberculosis hospitalizations in the United States are predominantly concentrated in urban teaching hospitals, likely reflecting their advanced diagnostic capacity, availability of isolation units, and multidisciplinary teams. Despite the greater number of patients, these centers exhibited lower in-hospital mortality, suggesting that access to specialized care and interdisciplinary management improves survival outcomes. In contrast, rural hospitals, although managing fewer cases, showed a higher relative mortality rate, suggesting limited resources and barriers to referral. Conclusion TB hospitalizations in the U.S. are concentrated in urban teaching hospitals, which show lower mortality but longer stay due to case complexity. Higher fatality rates in rural hospitals highlight the need for critical evaluation of healthcare system factors contributing to these outcome differences. This abstract is funded by: None