E0684 - Differences in Gastroparesis Hospitalizations Between Rural and Urban Settings

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Waseem Amjad, MD

Harvard Medical School
Boston, MA

Waseem Amjad, MD¹, Adnan Malik, MD², Muhammad Haseeb, MD¹, Umer Farooq, MD³, Andrew Ukleja, MD⁴
¹Harvard Medical School, Boston, MA; ²Mountain Vista Medical Center, Mesa, AZ; ³Loyola Medicine/MacNeal Hospital, Berwyn, IL; ⁴Beth Israel Deaconess Medical Center, Boston, MA

Introduction: Although gastroparesis is debilitating disease with high comorbidity burden, the data on the epidemiology of this disease is limited. We aim to determine rural vs. urban differences in outcomes of hospitalized gastroparesis patients.

Methods: We utilized the National Readmission Database (2010-2017) to study the outcomes of rural and urban populations in patients (delete) with history of gastroparesis. Associations of rural population with readmission and hospital resource utilization were computed in multivariable models adjusted for age, sex, presence of hypertension, diabetes, congestive heart failure, obesity, chronic kidney disease, pneumonia, HIV, alcohol use, smoking, disposition, teaching hospital status and insurance type.

Results: During 2010 – 2017, 2,053,840 patients (mean age 52.8 ± 17.2, 65.3% females) with history of gastroparesis had indexed hospital admissions. 214,711 (10.5%) patients were residing in rural area. The diabetes mellitus was highly prevalent (69.7%) in gastroparesis population. Hypertension, chronic kidney disease, end stage renal disease, diabetic complications, HIV and history of malignancy were more common in urban population whereas coronary artery disease, chronic obstructive pulmonary disease were more prevalent in rural population. The 30-day readmission rates (HR: 0.89, 95% CI: 0.86-0.92), median cost ($22,634 IQR: 12,850,42,658 vs. 31,394 17,443-59,734) (β: -13316, 95% CI -15264 to-11367) and median length of stay (4 days IQR: 2,6 vs. 4 days IQR: 2,7 β: -0.97, 95% CI: -1.1 to -0.83) were lower in rural vs. urban hospitalizations. The in-hospital mortality was similar in both groups. Diabetic ketoacidosis was the most common reason for 30-day readmission in rural population whereas diabetic neuropathy was the most common cause of readmission in urban group. The trends of 30-day readmission were improving in urban populations from 2010 to 2017.

Discussion: : The hospitalized rural gastroparesis population has lower comorbidity burden as compared to urban population. The 30-day readmission rates, hospital cost and length of stay were much lower in the rural population.

Figure: A. Kaplan Meier curve showing 30 days readmission of hospitalized rural vs. urban gastroparesis population
B. Trends of 30-day readmission of gastroparesis hospitalized patient from 2010 to 2017

Variables n=number of patients			Total gastroparesis patients (n=2,384,095)	Rural population (n =330,292)	Urban population (n=2,053,840)	P- value
Age			53.0 ± 16.7	53.5 ± 16.5	52.9 ± 16.7	< 0.001
Female			1,556,551 (65.3)	214,711 (65.0)	1,341,840 (65.3)	0.27
Smoker			511,931 (21.5)	73,127 (22.1)	438,805 (21.4)	0.02
Alcohol			47,458 (2.0)	5,884 (1.8)	41,575 (2.0)	< 0.001
Obesity			405,670 (17.0)	56,092 (17.0)	349,578 (17.0)	0.86
Hypertension			1,039,488 (62.4)	134,978 (60.9)	904,510 (62.6)	< 0.001
Type 1 DM			411,749 (17.3)	59,162 (17.9)	352,587 (17.2)	0.005
Type 2 DM			1,248,767 (52.4)	175,134 (53)	1,073,634 (52.3)	0.03
Diabetic retinopathy			198,473 (8.3)	22,905 (6.9)	175,568 (8.6)	< 0.001
Diabetic neuropathy			627,526 (26.3)	88,362 (26.8)	539,164 (26.3)	0.18
Diabetic nephropathy			259,042 (10.9)	32,852 (10.0)	226,190 (11.0)	< 0.001
COPD			174,409 (7.3)	30,971 (9.4)	143,438 (7.0)	< 0.001
Coronary artery disease			565,482 (23.7)	82,628 (25.0)	482,854 (23.5)	< 0.001
Congestive heart failure			728,433 (30.6)	100,306 (30.4)	628,127 (30.6)	0.5
Chronic kidney disease			552,153 (23.2)	71,564 (21.7)	480,589 (23.4)	< 0.001
ESRD			334,265 (14.0)	35,575 (10.8)	298,690 (14.5)	< 0.001
Malnutrition			217,134 (9.1)	30,010 (9.1)	187,124 (9.1)	0.89
Pneumonia			163,785 (6.9)	26,115 (7.9)	137,670 (6.7)	< 0.001
HIV			15,842 (0.7)	1,086 (0.3)	14,757 (0.7)	< 0.001
History of malignancy			126,355 (5.3)	15,813 (4.8)	110,542 (5.4)	< 0.001
Peptic ulcer disease			200,478 (8.4)	26,184 (7.9)	174,294 (8.5)	0.005
Nonvariceal upper GI bleeding			87,294 (3.7)	10.969 (3.3)	76,325 (3.7)	< 0.001
Lower GI bleeding			86,666 (3.6)	11,792 (3.6)	74,873 (3.7)	0.34
Septic shock			36,783 (1.5)	4,540 (1.4)	32,244 (1.6)	< 0.001
ICU admission			89,768 (3.8)	10,958 (3.3)	78,810 (3.8)	< 0.001
Teaching hospital			1,366,346 (57.3)	79,730 (24.1)	1,286,616 (62.6)	< 0.001
Insurance		Medicare	1,270,059 (53.4)	187,504 (57)	1,082,555 (52.8)	< 0.001
		Medicaid	473,251 (19.9)	61,691 (18.7)	411,561 (20.1)
		Private	468,711 (19.7)	55,655 (16.9)	413,056 (20.1)
		Self-pay	94,936 (4.0)	14,816 (4.5)	80,120 (3.9)
High Charlson comorbidity score			1,758,091 (73.7)	240,094 (72.7)	1,517,998 (73.9)	< 0.001
Disposition	Home		1,563,076 (65.6)	222,497 (67.4)	1,340,579 (65.3)	< 0.001
	Short term inpatient		18,135 (0.8)	4,402 (1.3)	13,732 (0.7)
	Transfer to SNF, ICF		317,217 (13.3)	43,663 (13.2)	273,554 (13.3)
	Home care		389,479 (16.3)	47,970 (14.5)	341,508 (16.6)

Table: Table 1: Baseline characteristics of gastroparesis indexed admissions from 2010- 2017.

Disclosures:

Waseem Amjad indicated no relevant financial relationships.

Adnan Malik indicated no relevant financial relationships.

Muhammad Haseeb indicated no relevant financial relationships.

Umer Farooq indicated no relevant financial relationships.

Andrew Ukleja indicated no relevant financial relationships.

Waseem Amjad, MD¹, Adnan Malik, MD², Muhammad Haseeb, MD¹, Umer Farooq, MD³, Andrew Ukleja, MD⁴. E0684 - Differences in Gastroparesis Hospitalizations Between Rural and Urban Settings, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.