ArticleHealth services research2022
Changes in economic outcomes before and after rural hospital closures in the United States: A difference-in-differences study.
Article in Health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Predictors of rural hospital closures in the United States: a systematic review and call for AI-driven early warning systems.BMC health services research · 2025Pooled it
- The digital divide in adoption and advanced use of electronic health records among US hospitals: rural versus urban disparities from 2008 to 2023.Journal of the American Medical Informatics Association : JAMIA · 2026Article
- Outcomes Among Medicare Beneficiaries After Cancer Surgery in Hospitals That Subsequently Closed.JAMA network open · 2026Article
- Mixed Evidence That Rural Hospitals' Finances Improved With Participation In The Pennsylvania Rural Health Model.Health affairs (Project Hope) · 2025Article
- Double vulnerability? Examining the effect of living in nonmetropolitan areas within non-expansion Medicaid states on health status among working-age adults in the United States, 2022-2024.SSM - population health · 2025Article
- Rural hospital closures and nursing home outcomes.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Understanding the impacts of rural hospital closures: A scoping review.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- The effect of nursing home closure on local employment in the United States.Health services research · 2023Article
- Causes and consequences of rural hospital closures.Journal of hospital medicine · 2022Article
- Changes in economic outcomes before and after rural hospital closures in the United States: A difference-in-differences study.Health services research · 2022Article
- Reimagining and reinvesting in rural hospital markets.Health services research · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectiveThe objective of this study is to assess changes in local economic outcomes before and after rural hospital closures. DATA SOURCES: Rural hospital closures from January 1, 2005, to December 31, 2018, were obtained from the Sheps Center for Health Services Research. Economic outcomes from this same period were obtained from the Bureau of Labor Statistics, Bureau of Economic Analysis, Quarterly Workforce Indicators, U.S. Federal Reserve Economic Data, RAND Corporation state statistics database, U.S. Social Security Administration, and U.S. Census Bureau.
designDifference-in-differences study of 2094 rural counties. DATA COLLECTION/EXTRACTION: The primary exposure was county-level rural hospital closures. The primary outcomes were county-level unemployment rates; employment-population ratios; labor force participation-population ratios; per capita income; total jobs; health care sector jobs; disability program participation-population ratios; percent of the population with subprime credit scores; total filings for bankruptcies per 1000 population; and population size. PRINCIPAL
findingsA total of 104 rural counties experienced a hospital closure, compared to 1990 rural counties that did not. Rural hospital closures were associated with significant reductions in health care sector employment (-13.8%; 95% CI: -22%, -5.6%; p < 0.001), but not with changes in any other economic measure. For unemployment rates, employment-population ratios, per capita income, disability program participation-population ratios, and total jobs, we found evidence of adverse trends preceding hospital closures. Findings were robust to adjusting for county-specific time trends, specifying exposure at the commuting zone-level, and using alternate definitions of rurality to define sample counties.
conclusionWith the exception of a decline in jobs within the health care sector, there was no association between rural hospital closures and county-level economic outcomes. Instead, economic conditions were already declining in counties experiencing closures compared to those that did not.
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