(1060) Comparing COVID-19 Outcomes Between Urban and Rural Hospitals

Introduction: COVID-19 has been responsible for causing almost 7 million deaths globally to date. The available evidence suggests that rural areas have experienced higher mortality rates compared to urban areas. Nevertheless, nationwide studies comparing in-hospital mortality are lacking. This nationwide study aims to investigate disparities in COVID-19 outcomes and resource utilization between rural and urban hospitals.

Methods: A total of 1,018,915 patients were identified from National Inpatient Sample (NIS) database who were 18 years or older and had COVID-19 as their primary admission diagnosis. Inpatient mortality was compared between urban and rural hospitals retrospectively. Univariate and multivariate analyses were performed, adjusting for confounding factors, including age, gender, race, insurance status, median income, comorbidity burden, hospital region, size, and teaching status. Secondary analyses were performed on length of stay and hospitalization cost, need for non-invasive (NIV), invasive (IMV), and IMV within 24 hours. Stata (StataCorp; College Station, TX) was used for statistical analysis.

Results: Inpatient mortality in urban hospitals was higher (OR 1.30 (1.20-1.40), p< 0.001) as compared to rural hospitals. The odds of overall need for IMV (OR 1.12 (1.04-1.21), p=0.002) and early initiation of IMV (OR 1.22(1.07-1.39), p=0.003) were higher in urban as compared to rural hospitals. No difference was noted in rates of NIV. Similarly, the length of stay and cost of hospitalization was higher in urban as compared to rural hospitals.

Conclusions: According to this study, urban hospitals demonstrate higher resource utilization but worse outcomes. The results of our study are contrary to current literature. Possibly, due to their prior experience in managing with constrained resources, rural hospitals were better equipped to adapt quickly and make the most of their available facilities and personnel during the pandemic. Furthermore, the sense of community and a shared commitment to protecting each other's health in rural areas might contribute to a more cohesive response. Optimizing resource utilization, even in abundance, could prove vital for better crisis response, ensuring preparedness and efficiency in times of crisis.