Purpose To evaluate the link between insurance status and patient length of stay (LOS) for inpatient admissions in rural and urban hospitals in Vermont. Methods We conducted a cross-sectional study utilizing 2016 to 2020 data from the Vermont Uniform Hospital at Data Discharge System (VUHDDS). Vermont residents 18-64 years of age admitted for heart and circulatory illnesses who spent least one day as inpatient at one of Vermont's 14 hospitals were included. Frequency statistics were run to determine distribution of sample characteristics and a two-side Z-test was conducted to compare differences between normal and extended lengths of stay. Three multivariate logistic regression models were utilized to control for confounding factors and identify differences in lengths of stay and mortality. Findings Private insurance was more common among patients with a normal LOS (46%) and public insurance more common among patients with extended lengths of stay (54%). Rural Medicare patients have 0.77 (CI: 0.66-0.90) times lower odds of extended LOS, which is distinct from the 95% confidence interval for urban patients (CI: 0.94-1.46). Urban Medicaid insured patients had 1.413 (CI: 1.15-1.74) times greater odds of an extended LOS, which is outside of the 95% confidence interval for rural patients (CI: 0.80-1.09). Conclusions In conclusion, the rurality of a patient's residence appears to impact health outcomes for cardiac related discharges for individuals in Vermont related to their insurer. Further studies with more demographic data are needed to better understand the implications of these findings.

The authors have declared no competing interest.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of Univerisity of Vermont waived ethical approval for this work as an exept researh project. Study utilized deidentified dataset.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes