Key result
Rural hospitalization for concurrent HF and cirrhosis is linked to ~12% higher in-hospital mortality.
Why the study?
Urbanization-related disparities in outcomes and healthcare utilization among patients hospitalized with concurrent heart failure and liver cirrhosis have not been comprehensively investigated.
Does rural hospital admission increase in-hospital mortality in adult patients with concurrent heart failure and liver cirrhosis?
Observational (n=498,539)
Yes
Does rural hospital admission increase in-hospital mortality in adult patients with concurrent heart failure and liver cirrhosis?
Odds Ratio: 1.116 (95% CI 1.081–1.153)
Absolute Event Rate: 8% vs 7.3%
p-value: p=<0.001
Rural hospitalizations for concurrent heart failure and liver cirrhosis are associated with significantly higher in-hospital mortality despite shorter hospital stays and lower costs compared to urban hospitalizations, highlighting key geographic healthcare disparities.
Rural-urban mortality gap in HF-cirrhosis warrants targeted resource evaluation; leaves open whether access, quality, or case mix drive the association.
Heart failure and cirrhosis interplay predisposes patients to increased inpatient morbidity, acute decompensation, renal injury, infection, procedural complications, prolonged hospitalizations, and healthcare costs. In this retrospective observational study, we analyzed data from the Nationwide Inpatient Sample spanning 2016 to 2022 to assess rural-urban disparities and temporal trends in adult patients hospitalized with concurrent HF and liver cirrhosis in the U.S. Validated International Classification of Diseases, 10th Revision codes were used to identify these patients. A total of 498,539 hospitalizations (weighted >2.49 million) met inclusion criteria, of which 14.9% occurred in non-metropolitan hospitals and 85.1% in metropolitan hospitals. In-hospital mortality was higher in rural settings (8.0% vs. 7.3%), with slightly longer hospital stays in urban settings that incurred a greater financial burden, with higher inflation-adjusted costs ($24,026 vs. $20,948). These results were consistent with propensity-matching. The study concludes that strategies to improve regional healthcare access and equity in complex multisystem disease management are needed.
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Yasmin et al. (2026) conducted an observational in Concurrent Heart Failure and Liver Cirrhosis (n=498,539). Rural hospital setting vs. Urban (metropolitan) hospital setting was evaluated on In-hospital mortality (aOR 1.116, 95% CI 1.081 to 1.153, p=<0.001). Rural hospitalization for concurrent heart failure and liver cirrhosis was associated with higher in-hospital mortality compared to urban settings (8.0% vs. 7.3%; aOR 1.116).
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