Table 4. Changes in Rural-Urban Resident Disparities in Mortality, Hospital Returns, Postadmission Institution Time, and Spending, 2008 vs 2017a.
| Outcome | Patients, No. (%) | Adjusted change in disparity from 2008 to 2017, estimate (95% CI) | |||||
|---|---|---|---|---|---|---|---|
| 2008 | 2017 | ||||||
| Rural | Urban | Unadjusted disparity | Rural | Urban | Unadjusted disparity | ||
| Mortality from admission (%), d | |||||||
| 30 | 9501 (9.7) | 24 353 (9.1) | 0.5 (0.3-0.8) | 8044 (9.3) | 21 212 (8.8) | 0.5 (0.3-0.7) | 0.28 (−0.04 to 0.60) |
| 90 | 13 981 (14.3) | 36 421 (13.7) | 0.6 (0.3-0.8) | 11 610 (13.4) | 31 364 (12.9) | 0.4 (0.2-0.7) | 0.28 (−0.02 to 0.59) |
| 180 | 17 857 (18.2) | 46 991 (17.7) | 0.6 (0.3-0.8) | 14 783 (17.0) | 40 540 (16.7) | 0.3 (0.0-0.6) | 0.28 (−0.11 to 0.66) |
| All-cause returns to hospital 30 d from discharge (%) | 24 639 (25.1) | 57 274 (21.5) | 3.6 (3.3-3.9) | 23 209 (26.8) | 53 790 (22.2) | 4.6 (4.2-4.9) | 0.91 (0.35-1.48) |
| Institution at 90 d (%) | 9856 (10.1) | 28 630 (10.8) | −0.7 (−0.9 to −0.5) | 7393 (8.5) | 21 730 (9.0) | −0.4 (−0.7 to −0.2) | 0.40 (−0.02 to 0.83) |
| Institution time within 90 d, mean (SD), d | 19.0 (26.0) | 20.6 (26.6) | −1.6 (−1.8 to −1.4) | 17.7 (24.7) | 19.0 (24.9) | −1.3 (−1.5 to −1.1) | 0.52 (0.20-0.83) |
| Total spending, mean (SD), $ | 19 858 (20 564) | 23 646 (24 218) | −3788 (−4169 to −3407) | 25 697 (26 979) | 28 701 (29 275) | −3004 (−3500 to −2508) | −849 (−1606 to −92) |
| Inpatient | 7976 (10 091) | 9829 (13 986) | −1852 (−1948 to −1757) | 9632 (12 550) | 11 484 (14 872) | −1852 (−1963 to −1741) | −16 (−235 to 203) |
| Skilled nursing facility | 4429 (10 215) | 4692 (10 434) | −263 (−339 to −187) | 4994 (12 156) | 4975 (11 617) | 19 (−72 to 110) | −369 (−625 to −113) |
| Professional fees | 2615 (2750) | 3346 (3071) | −731 (−780 to −682) | 3622 (3685) | 4110 (3617) | −489 (−552 to −426) | −241 (−324 to −158) |
| Outpatient hospital | 1440 (2205) | 868 (1779) | 572 (558-586) | 2788 (3938) | 1772 (3280) | 1016 (989-1043) | −434 (−558 to −308) |
Unadjusted disparities are the rural mean in each year less the urban mean. The adjusted disparities shown in the final column are the estimated differences between rural and urban changes in each outcome between 2008 and 2017 after adjusting for patient age, sex, race/ethnicity, Medicaid enrollment in prior 12 months, original Medicare entitlement reason (whether for age, disability or end-stage kidney disease), and 27 indicators for chronic conditions prior to admission. Standard errors were clustered by beneficiary state, and 95% CIs are presented along with our estimates. Negative adjusted changes indicate disparities that have become smaller during the study period. Positive adjusted changes indicate disparities that have become larger during the study period. See the eAppendix in the Supplement for a discussion of how our mortality measures differ from the Centers for Medicare & Medicaid Services’ Hospital Compare mortality measure for stroke.