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Research ArticleOriginal Research

The Influence of Hospital Urbanicity on Mortality in Patients With Acute Respiratory Failure: A National Cohort Retrospective Analysis

Brittany N Burton, Suraj Trivedi, Alexander Beletsky, Ana Mitchell, Emily Nasser, Ulysses Cázares, Maxime Cannesson, Ulrich H Schmidt and Rodney A Gabriel
Respiratory Care December 2021, 66 (12) 1789-1796; DOI: https://doi.org/10.4187/respcare.09003
Brittany N Burton
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California.
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Suraj Trivedi
Department of Anesthesiology, University of California, San Diego, La Jolla, California.
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Alexander Beletsky
Department of Radiology, University of California, Davis, Davis, California.
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Ana Mitchell
School of Medicine, University of California, San Diego, La Jolla, California.
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Emily Nasser
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California.
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Ulysses Cázares
Department of Biomedical Sciences, California University of Science and Medicine, Colton, California.
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Maxime Cannesson
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California.
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Ulrich H Schmidt
Department of Anesthesiology, University of California, San Diego, La Jolla, California.
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Rodney A Gabriel
Department of Anesthesiology, University of California, San Diego, La Jolla, California.
Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, California.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: The primary objective of this study was to employ a national database to evaluate the association of hospital urbanicity, urban versus rural, on mortality and length of hospital stay in patients hospitalized with acute respiratory failure.

METHODS: We used the 2014 National Inpatient Sample database to evaluate the association of hospital urbanicity with (1) mortality and (2) prolonged hospital stay, defined as ≥ 75th percentile of the study population. We conducted a mixed-effects logistic regression analysis adjusting for sociodemographic variables and medical comorbidities. The random effect was hospital identification number (a unique value assigned in the NIS database for a specific institution). The odds ratio (OR), 95% CI, and P values were reported for each independent variable.

RESULTS: The odds of inpatient mortality were significantly higher among urban teaching (OR 1.39, 95% CI 1.39–1.66, P < .001) and urban nonteaching hospitals (OR = 1.39, 95% CI 1.26–1.52, P < .001) compared to rural hospitals. The odds of prolonged hospital stay were significantly higher among urban teaching (OR = 1.82, 95% CI 1.66–2.0, P < .001) and urban nonteaching compared to rural hospitals (OR = 1.50, 95% CI 1.36–1.65, P < .001).

CONCLUSIONS: This study supports the current body of literature that there are significant differences in patient populations among hospital type. Differences in health outcomes among different types of hospitals should be considered when designing policies to address health equity as these are unique populations with specific needs.

  • urban
  • rural
  • disparity
  • mortality
  • hospital length of stay
  • respiratory failure

Footnotes

  • Correspondence: Rodney A Gabriel MD MAS, University of California, San Diego, Department of Anesthesiology, 200 West Arbor Drive, San Diego, CA 92103. E-mail: ragabriel{at}ucsd.edu
  • See the Related Editorial on Page 1924

  • The authors have no conflicts to disclose.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (12)
Respiratory Care
Vol. 66, Issue 12
1 Dec 2021
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The Influence of Hospital Urbanicity on Mortality in Patients With Acute Respiratory Failure: A National Cohort Retrospective Analysis
Brittany N Burton, Suraj Trivedi, Alexander Beletsky, Ana Mitchell, Emily Nasser, Ulysses Cázares, Maxime Cannesson, Ulrich H Schmidt, Rodney A Gabriel
Respiratory Care Dec 2021, 66 (12) 1789-1796; DOI: 10.4187/respcare.09003

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The Influence of Hospital Urbanicity on Mortality in Patients With Acute Respiratory Failure: A National Cohort Retrospective Analysis
Brittany N Burton, Suraj Trivedi, Alexander Beletsky, Ana Mitchell, Emily Nasser, Ulysses Cázares, Maxime Cannesson, Ulrich H Schmidt, Rodney A Gabriel
Respiratory Care Dec 2021, 66 (12) 1789-1796; DOI: 10.4187/respcare.09003
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Keywords

  • urban
  • rural
  • disparity
  • mortality
  • hospital length of stay
  • respiratory failure

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