Rural-dwelling patients with rheumatoid arthritis have higher risk of myocardial infarction hospitalization: an observational study using the National Inpatient Sample.

Singh JA, Chandrupatla SR. Rural-dwelling patients with rheumatoid arthritis have higher risk of myocardial infarction hospitalization: an observational study using the National Inpatient Sample. The Journal of rheumatology. 2025 Apr 1 DOI: 10.3899/jrheum.2024-1036.

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Abstract:

OBJECTIVE: To assess whether there is a rural-urban and income-related disparity in the incidence and outcomes of myocardial infarction (MI) hospitalization in patients with rheumatoid arthritis (RA). METHODS: We used the 2016-2019 U.S. National Inpatient Sample (NIS) data and selected all patients with RA. Rural versus urban residential status was identified using NIS classifications. We categorized median household income based on patient ZIP code by quartile. We assessed the multivariable-adjusted odds ratios (aOR) to examine the association of rural residence with MI hospitalization. RESULTS: The crude rate of MI hospitalization per 100,000 area-specific hospitalizations in people with RA was significantly higher for rural versus urban residents, 2,441 versus 1,878 (p < 0.001). In multivariable-adjusted models, compared to urban residents, rural-residing residents with RA were almost twice as likely to be hospitalized with MI (aOR: 1.70; p < 0.001). Rural residence was not significantly associated with higher hospital charges or MI hospitalization costs (p > 0.05) Compared to the lowest quartile, the two highest income quartiles were significantly associated with lower odds of MI hospitalization in patients with RA, aOR were 0.92 (p = 0.01) and 0.87 (p < 0.001). Female sex, African American race, elective admission, Medicare payer, government hospital control, rural hospital location, small hospital bed size, were significantly associated with lower odds of MI hospitalization. CONCLUSION: Our study findings of rural-urban and SES disparities for MI hospitalizations in patients with RA provide policymakers with data and information for action. Policy decisions based on these data can potentially reduce these disparities and improve outcomes for rural residents.