Rural–urban disparities in acute pancreatitis outcomes: A retrospective cohort study using the National Inpatient Sample (2016–2021)

Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States. Rural–urban healthcare disparities may influence access to care, disease severity, and outcomes; however, national data comparing these populations remain limited. We compared inpatient outcomes and healthcare utilization between rural and urban AP hospitalizations. We performed a retrospective cohort study using the National Inpatient Sample (2016–2021) to identify adult hospitalizations with a primary diagnosis of AP. Hospitalizations were classified as rural or urban. Multivariable logistic regression estimated adjusted odds ratios (aORs) for in-hospital mortality and complications. Multivariable linear regression assessed differences in length of stay and inflation-adjusted hospitalization costs after adjusting for demographics, comorbidities, and hospital characteristics. A total of 1,549,845 weighted AP hospitalizations were identified, including 1,289,970 (83.23%) urban and 259,875 (16.77%) rural hospitalizations. Rural hospitalizations had higher in-hospital mortality (0.59% vs 0.56%; aOR 1.38, 95% confidence interval: 1.18–1.62; P < .001). Rural patients had greater odds of complications, including acute kidney injury (aOR 1.06), vasopressor use (aOR 1.55), invasive mechanical ventilation (aOR 1.46), noninvasive ventilation (aOR 1.37), hemodialysis (aOR 1.31), acute respiratory distress syndrome (aOR 1.41), acute liver failure (aOR 1.27), necrotizing pancreatitis (aOR 1.61), and packed red blood cell transfusion (aOR 1.22; all P ≤ .016). Despite worse outcomes, rural hospitalizations had a shorter length of stay (−0.32 days; P < .001) and lower inflation-adjusted costs (−$11,343.80; P = .005). Rural AP hospitalizations were associated with higher mortality and severe complications despite shorter stays and lower costs, highlighting geographic disparities and the need to improve access to specialized care.