B25-07 Rural-Urban Disparities in In-Hospital Outcomes Among Patients With Septic Shock in the United States

Abstract Background Geographic disparities in critical care delivery may contribute to differences in septic shock outcomes, yet national data characterizing rural-urban differences remain limited. We evaluated mortality, complications, and use of life-sustaining therapies among hospitalized adults with septic shock in the United States. Methods We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022). Adult hospitalizations with a diagnosis of septic shock were identified, and hospitals were categorized as urban or rural. The primary outcome was in-hospital mortality; secondary outcomes included major complications and organ support use. Multivariable logistic regression was performed adjusting for demographics and comorbidities. Results Among 6,872,978 septic shock hospitalizations, 84.35% occurred in urban and 15.65% in rural hospitals. Rural patients were slightly older and more frequently from lower-income quartiles. Crude mortality was similar between groups (urban: 20.63% vs rural: 20.57%). After adjustment, rural hospitalizations had higher odds of in-hospital mortality (aOR 1.03; 95% CI 1.01-1.05; p 0.001). Rural patients had higher odds of acute respiratory distress syndrome (aOR 1.08), cardiac arrest (aOR 1.05), and acute myocardial infarction (aOR 1.05) (all p 0.001). They had lower odds of receiving vasopressors (aOR 0.89), invasive mechanical ventilation (aOR 0.91), noninvasive ventilation (aOR 0.92), and hemodialysis (aOR 0.91), and were less frequently diagnosed with venous thromboembolism (aOR 0.87) (all p 0.001). Conclusion Rural septic shock hospitalizations were associated with higher adjusted mortality and lower use of organ support therapies. These differences may reflect variations in resource availability and critical care delivery. Efforts to strengthen early sepsis recognition, critical care capacity, and transfer pathways in rural settings are warranted. This abstract is funded by: None