Primary outcome.

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.

研究背景与目的
神经医疗领域的城乡诊疗差异已有充分文献报道，但针对吉兰-巴雷综合征（Guillain-Barré Syndrome, GBS）的相关研究数据仍十分有限。本研究旨在分析美国城乡医院收治的吉兰-巴雷综合征患者的人口学特征、医院属性及临床结局差异。
研究方法
本研究依托2021年全国住院患者样本（National Inpatient Sample, NIS），针对以吉兰-巴雷综合征为主要诊断的成人住院病例开展回顾性队列研究。本研究参照美国人口普查局的区划标准，将医院划分为农村医院与城市医院两类。采用多因素logistic回归与线性回归模型，在校正人口学、临床及医院层面混杂因素后，分析医院区位与临床结局之间的关联。
研究结果
经加权估算，共确认约10035例吉兰-巴雷综合征住院病例，其中95.8%收治于城市医院。农村医院收治患者的平均年龄为56.8岁（95%置信区间：52.5~61.0），显著高于城市医院收治患者的51.3岁（95%置信区间：50.3~52.2）。校正混杂因素后的分析显示，两组患者的院内死亡率（校正比值比：2.00；95%置信区间：0.11~35.12）与住院时长（平均差值：-1.85天；95%置信区间：-6.62~2.91）均无显著统计学差异。但城市医院的总住院费用显著更高，平均费用差为39474美元（95%置信区间：4296~74651美元）。两组患者的出院结局无显著差异：农村医院收治患者中40%出院回家，城市医院为48.1%；农村医院38.8%的患者出院至专业护理机构，城市医院为43.3%（所有比较的P值均>0.05）。
研究结论
本针对超过10000例吉兰-巴雷综合征住院病例的全国性分析显示，城乡医院在院内死亡率、住院时长、并发症及出院结局方面的临床表现相当。农村医院收治的患者多为来自低收入地区的高龄人群，而城市医院收治的合并严重基础疾病的病例更多，且产生的医疗费用也显著更高。上述研究结果表明，农村医院能够为吉兰-巴雷综合征患者提供有效的急性期诊疗服务，同时也提示未来有必要开展跨地域的长期功能结局相关研究。