Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal
The NC Rural Health Research Program tracks and studies rural hospital closures. Our most recent brief, Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal, describes the socio‐economic, demographic, and health system characteristics for rural counties with and without hospital closures between 1990 and 2020. For the purposes of this analysis, we defined closures as either 1) facilities where health care services are no longer provided (“complete closures”), or 2) facilities where health care services (such as primary care, skilled nursing care, and rehabilitation) are provided, but inpatient services are no longer provided (“converted closures”). Between 1990 and 2020, there were 334 documented rural hospital closures in 44 states. Between 1990‐1999, there were 119 rural hospital closures in the U.S. Thereafter, the number of rural hospital closures declined to 74 between 2000‐2009 and increased to 141 between 2010‐2020.
Closures were more likely to occur in a county with more non‐white residents between 1990 and 2020; and conversely, the share of white residents decreased in rural closure counties. This also bore out in the percentiles, where rural closure counties had higher‐than‐median proportions of Black, Hispanic, and American Indian residents, compared with rural counties overall. We also found that between 1990 and 2020, rural closure counties became more economically unequal, with higher unemployment, lower per capita income, and lower median household incomes compared with rural counties overall. Finally, we found that between 1990 and 2020, rural closure counties were increasingly likely to be primary care and dental health service professional shortage areas prior to the closure of a hospital within their borders.