{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:33:29Z","timestamp":1777883609615,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Substantial gaps in clinical outcomes exist in rural and urban hospitals in the United States. Our findings highlight the impact of geographic location on hospital care, guiding targeted interventions to improve opioid-related outcomes in rural and urban areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used the National Inpatient Sample to examine trends in hospitalizations, in-hospital mortality, length of stay, and inflation-adjusted cost of adults admitted for an opioid overdose between 2016 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Between 2016 and 2021, age-adjusted hospitalizations consistently declined across urban, rural, and overall populations. Urban hospitalization rates decreased from 700 to 500\u2009per 100\u2009000, while rural rates fell from 150 to under 100\u2009per 100\u2009000. Strong negative correlations indicated significant downward trends in hospitalizations across all groups (urban and total: \u03c4\u2009=\u2009\u22120.99,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.008; rural: \u03c4\u2009=\u2009\u22120.99,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.009). Rural patients had higher odds of in-hospital mortality (OR [95% CI]: 1.24 [1.1-1.4],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), requiring invasive mechanical ventilation (OR [95% CI]: 1.46 [1.37-1.56],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and hemodialysis (OR [95% CI]: 1.64 [1.42-1.89],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), with similar findings in propensity-matched cohorts. Additionally, rural patients were more likely to develop venous thromboembolism (VTE) (OR [95% CI]: 1.20 [1.00-1.43],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.045), anoxic brain damage (OR [95% CI]: 1.15 [1.02-1.30],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.025), and acute liver failure (OR [95% CI]: 1.34 [1.18-1.53],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), although VTE did not reach significance in matched cohorts (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.120). Rural hospitalizations incurred lower inflation-adjusted costs by $1367.89 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and had a shorter adjusted length of stay by 0.49\u2009days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) compared to urban settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In conclusion, significant disparities in outcomes for opioid overdose patients highlight challenges in rural health care, including higher in-hospital mortality and complications. Continued healthcare policy reforms are warranted to alleviate the disparities in rural-urban cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342251370455","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T09:49:21Z","timestamp":1761558561000},"page":"384-397","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rural-Urban Disparities in Inpatient Outcomes for Opioid Overdose: A Nationwide Analysis"],"prefix":"10.1177","volume":"47","author":[{"given":"Muhammad Ahmad","family":"Nadeem","sequence":"first","affiliation":[{"name":"Department of Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed A.","family":"Quazi","sequence":"additional","affiliation":[{"name":"Department of Family and Community Health, West Virginia University, Morgantown, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tristen A.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-8759","authenticated-orcid":false,"given":"Abdul Rafeh","family":"Awan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Nishtar Medical University, Multan, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir H.","family":"Sohail","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, University of New Mexico, Albuquerque, NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeel","family":"Nasrullah","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abu Baker","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6450a3"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1424"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000625"},{"key":"e_1_3_3_5_2","unstructured":"Owens P Barrett M Weiss A Washington R Kronick R. 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