Comparing Guillain-Barré syndrome outcomes between rural and urban hospitals in the United States: A retrospective cohort study

Abstract

Background and purpose Rural-urban disparities in neurological care have been well documented, but limited data exist regarding Guillain-Barré Syndrome (GBS). This study examines differences in patient demographics, hospital characteristics, and outcomes among GBS admissions to rural versus urban hospitals in the United States. Methods Using the 2021 National Inpatient Sample, we conducted a retrospective cohort study of adult hospitalizations with a principal diagnosis of GBS. Hospitals were classified as rural or urban based on U.S. census designations. Multivariate logistic and linear regression models were used to assess associations between hospital location and outcomes, adjusting for demographic, clinical, and hospital-level factors. Results An estimated 10,035 weighted Guillain-Barré Syndrome hospitalizations were identified, of which 95.8% occurred in urban hospitals. Rural hospitalizations involved older individuals (mean age 56.8 years; 95% CI: 52.5–61.0) compared to urban hospitalizations (51.3 years; 95% CI: 50.3–52.2). Adjusted analyses showed no significant differences in in-hospital mortality (adjusted OR 2.00; 95% CI: 0.11–35.12) or length of stay (mean difference −1.85 days; 95% CI: −6.62 to 2.91). However, total hospital charges were significantly higher in urban hospitals, with an average difference of $39,474 (95% CI: $4,296–$74,651). Discharge disposition was comparable, with 40% of rural hospitalizations and 48.1% of urban hospitalizations discharged home, and 38.8% versus 43.3% discharged to skilled nursing facilities (all p > 0.05). Conclusions In this national analysis of over 10,000 Guillain-Barré Syndrome hospitalizations, rural and urban hospitals achieved comparable outcomes in terms of in-hospital mortality, length of stay, complications, and discharge disposition. Rural hospitalizations tended to involve older individuals from lower-income areas, whereas urban hospitals managed more cases with severe comorbidities and generated substantially higher costs. These findings suggest that rural hospitals are capable of delivering effective acute care for GBS, and highlight the need for future research on long-term functional outcomes across geographic settings.