JAMA study finds urban and rural hospitals close at similar rates, with closures tied to poverty and limited transportation

Hospitals are closing in both urban and rural settings at roughly similar rates, according to a study published Thursday in the Journal of the American Medical Association (JAMA), a finding that challenges the idea that hospital shutdowns are primarily a rural problem. The paper, authored by researchers at the Harvard T.H. Chan School of Public Health, examined patterns of hospital closures and compared differences across community types.

The study concluded that urban hospitals shut down at about the same rate as rural hospitals. It also found that hospitals that closed were more likely to have served communities with higher poverty levels. In addition, the shuttered hospitals were more likely to be located in areas where transportation options were more limited, a factor researchers connected to potential access barriers for patients who depend on reaching hospitals in emergencies.

While the study focuses on national patterns, its framing centers on access to care as closures occur. Researchers said the communities served by closing hospitals tended to face multiple challenges at once, including economic strain and practical obstacles to travel. Those conditions can affect whether patients can seek treatment promptly, particularly for time-sensitive care such as emergency treatment.

The findings carry implications for how policymakers and health systems think about sustaining hospital capacity, since the results suggest the risk of closure is not limited to areas with low population density. If closures can occur in urban neighborhoods as well as rural counties, responses that target only geographic distance from care may miss parts of the problem.

For Kentucky, the study’s emphasis on poverty and transportation access highlights variables that often shape health outcomes and care-seeking behavior, including for residents who may have fewer reliable travel options. In communities where getting to a facility requires longer trips or multiple transit steps, a closure can reduce the practical ability to access services even when alternative facilities exist.

JAMA has published multiple studies in recent years examining hospital closures and their downstream effects, and Thursday’s paper adds to that body of evidence by focusing on how closure rates compare between urban and rural settings and what characteristics are most common among the communities served by closing hospitals. The authors used hospital closure data and community-level measures to identify patterns tied to poverty and mobility.

The study’s conclusions suggest that decisions about hospital sustainability and health system planning may need to be informed by more than geography alone. If closures track poverty and transportation access as strongly as community type, efforts to protect capacity may require targeted approaches aimed at the least served populations.

As the research reaches clinicians, regulators, and health administrators, the next phase will likely involve how leaders interpret the findings for their own service areas and whether existing strategies for maintaining emergency readiness and inpatient access incorporate mobility barriers alongside economic measures.