P4074 - Urban and Rural Disparities in Peptic Ulcer Disease in the United States

Gicel Jacklin. Aguilar, DO¹, Alan Gabriel. Ortega Macias, MD², Niloy Ghosh, MD³, Amir Sohail, MD, MSc², Mohammed Quazi, PhD⁴, Abu Baker Sheikh, MD³
1University of New Mexico Hospital, Albuquerque, NM; 2University of New Mexico, Albuquerque, NM; 3University of New Mexico Health Sciences Center, Albuquerque, NM; 4West Virginia University, Morgantown, WV

Introduction: Peptic ulcer disease (PUD) affects approximately 4 million people annually worldwide and accounts for significant morbidity and mortality. Despite declining prevalence due to advances in H. pylori management and proton pump inhibitor use, disparities in outcomes persist, particularly between urban and rural populations. Rural patients often face higher mortality rates and limited access to advanced care services, reflecting systemic healthcare inequities. This study explores urban-rural disparities in inpatient outcomes of PUD using a nationally representative database.

Methods: We analyzed the National Inpatient Sample (NIS) database (2016–2021) to identify hospitalizations with a primary diagnosis of PUD. Baseline demographics and outcomes were compared between urban and rural populations. Propensity score matching (PSM) was used to adjust for confounders, including age, sex, and comorbidities. Outcome measures included complication rates, resource utilization, and in-hospital mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess associations between geographic location and outcomes.

Results: Among 122,410 PUD hospitalizations, 81.13% (n = 99,315) were from urban areas, and 18.87% (n = 23,095) were from rural regions. Rural patients were older (47.43% vs. 45.67% aged ≥70 years, p < 0.001) and predominantly White (84.67% vs. 68.42%, p < 0.001), with lower median household incomes (53.34% vs. 24.43% earning ≤$51,999, p < 0.001). Post-PSM rural patients exhibited significantly worse outcomes, including higher odds of invasive mechanical ventilation (OR 2.02; 95% CI: 1.23–3.33; p = 0.005), vasopressor use (OR 2.17; 95% CI: 1.02–4.72; p = 0.048), and in-hospital mortality (OR 4.05; 95% CI: 1.97–8.32; p < 0.001). Rural PUD patients were less likely to receive diagnostic esophagogastroduodenoscopy (EGD; OR 0.63; 95% CI: 0.50–0.80; p < 0.001) or packed red blood cell transfusions (OR 0.66; 95% CI: 0.58–0.75; p < 0.001).

Discussion: PUD patients in rural settings face higher odds of requiring advanced organ support and experience reduced access to critical interventions like EGD and transfusions. These disparities likely reflect resource limitations in rural healthcare settings, contributing to the observed higher mortality risk. These findings underscore the need for centralized, well-equipped facilities supported by robust logistical networks to improve outcomes for critically ill patients in underserved areas.

Disclosures:
Gicel Aguilar indicated no relevant financial relationships.
Alan Ortega Macias indicated no relevant financial relationships.
Niloy Ghosh indicated no relevant financial relationships.
Amir Sohail indicated no relevant financial relationships.
Mohammed Quazi indicated no relevant financial relationships.
Abu Baker Sheikh indicated no relevant financial relationships.

Gicel Jacklin. Aguilar, DO¹, Alan Gabriel. Ortega Macias, MD², Niloy Ghosh, MD³, Amir Sohail, MD, MSc², Mohammed Quazi, PhD⁴, Abu Baker Sheikh, MD³. P4074 - Urban and Rural Disparities in Peptic Ulcer Disease in the United States, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.