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Rural-Urban Disparities in Heart Failure and Liver Cirrhosis Hospitalizations: A National Inpatient Sample Database
Farah Yasmin1, Yusra Mashkoor2, Maryam Shahryar3
1Yale School of Medicine, New Haven, CT, USA.
International Journal of Heart Failure
|August 8, 2026
Summary
Hospitalizations for heart failure (HF) and cirrhosis show rural-urban disparities. Rural patients experienced higher in-hospital mortality, while urban patients faced greater financial burdens, highlighting the need for equitable healthcare access.
Area of Science:
- Cardiology
- Hepatology
- Health Services Research
Background:
- Concurrent heart failure (HF) and liver cirrhosis significantly increase inpatient morbidity, mortality, and healthcare costs.
- Understanding rural-urban disparities in managing this complex comorbidity is crucial for improving patient outcomes.
- Previous research has not fully elucidated temporal trends and regional variations in hospitalizations for combined HF and cirrhosis.
Purpose of the Study:
- To assess rural-urban disparities in hospitalizations for concurrent heart failure and liver cirrhosis in the U.S. from 2016 to 2022.
- To analyze temporal trends in inpatient outcomes and healthcare utilization for this patient population.
- To identify differences in mortality, hospital stay duration, and costs between metropolitan and non-metropolitan hospital settings.
Main Methods:
- Retrospective observational study utilizing the Nationwide Inpatient Sample (NIS) database from 2016 to 2022.
- Identification of adult patients with concurrent heart failure and liver cirrhosis using validated International Classification of Diseases, 10th Revision (ICD-10) codes.
- Comparison of in-hospital mortality, length of stay, and inflation-adjusted costs between patients treated in metropolitan and non-metropolitan hospitals, with propensity score matching.
Main Results:
- A total of 498,539 hospitalizations (weighted >2.49 million) met inclusion criteria.
- Non-metropolitan hospitals accounted for 14.9% of these hospitalizations, while metropolitan hospitals handled 85.1%.
- In-hospital mortality was higher in rural settings (8.0% vs. 7.3%), whereas urban hospitalizations had longer stays and higher inflation-adjusted costs ($24,026 vs. $20,948).
Conclusions:
- Significant rural-urban disparities exist in the management and outcomes of patients hospitalized with concurrent heart failure and liver cirrhosis.
- Higher mortality in rural areas and greater financial burden in urban areas necessitate targeted strategies.
- Improved regional healthcare access and equitable management approaches are essential for this complex patient population.
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