Background/Purpose: To assess whether rural-urban disparities exist in people with SLE for hospitalization with myocardial infarction (MI)

Methods: We used the 2016-2019 U.S. National Inpatient Sample (NIS) data that contain all hospitalization data are nationally representative. In people with SLE, we assessed the multivariable adjusted odds ratios (aOR) to examine the association of rural residence with MI hospitalization with urban residence as the reference category, while adjusting for demographics, payer, income, hospital characteristics, and the Deyo-Charlson Comorbidity Index, a composite validated comorbidity score commonly used to account for the varying effect of 19 common comorbidities.

Results: We found that the crude rates of patients hospitalized with MI per 100,000 area specific SLE hospitalizations were higher in rural versus urban residents with SLE, 2,387 versus 1,518 (p-value < 0.001). In multivariable-adjusted model that accounted for demographics, insurance payer, household income, comorbidities, hospital characteristics including geographic location, we found that rural residence was associated with an odds ratio (OR), 2.04 (95% CI, 1.75, 2.38) of myocardial infarction (MI) hospitalizations in people with SLE.  Other factors significantly associated with the risk of MI were male sex, a higher Deyo-Charlson index, Medicaid or private insurance, urban not teaching or urban teaching hospital, Midwest, or West region, and a private hospital control, either for profit or not for profit. Sensitivity analyses that limited data to non-elective hospitalizations, or included interaction terms for rural*sex, rural*age, and rural*Deyo-Charlson index confirmed the main model findings with minimal attenuation of odds ratio.

Conclusion: Rural residence was associated with twice the risk of MI hospitalization in people with SLE. This association was independent of demographics, payer status, social determinants of health, hospital characteristics, and geographical location. Our study highlights, the disproportionate effect of rurality for health outcomes in people with SLE within the US and a stark rural-urban gap disparity. Interventions to reduce this disparity are needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rural-urban-disparities-in-the-myocardial-infarction-hospitalizations-in-people-with-systemic-lupus-erythematosus-in-the-us/