Abstract P224: Rural Hospital Closures Are Associated With Increased Mortality From Ischemic Heart Disease: A County-Level Analysis

Abstract

Objective: Ischemic heart disease remains the leading cause of death in the United States; yet mortality from heart disease is geographically heterogeneously distributed. From 2011 - 2020, several hospitals across the US have closed. In this study we will investigate the impact of hospital closure on county level disease-specific mortality data. We hypothesize that rural hospital closures will be associated with increased risk of mortality from ischemic heart disease. Methods: The CDC-Wonder database, an online outcomes reporting system was queried for county level, ischemic heart disease specific mortality in Texas - the state with the largest number of hospital closures. Demographic, socioeconomic, and comorbidity information was collated from the County Health Ranking project. Hospital closure data was obtained from the Sheps Center for Health Services Research. Counties were grouped by Health Service Area (HSA) and were considered affected if any county in the HSA was affected by a hospital closure. A difference in difference analysis with unbiased staggered adoption was performed with a multivariate linear model. 4 counties with multiple hospital closures in the time frame were excluded from analysis. Results: Over a 10-years (2011 - 2020) 247,712 deaths were recorded as related to ischemic heart disease in Texas. Difference-in-difference analysis with all counties did not demonstrate a significant treatment effect of hospital closure (ATT = - 0.01, p = 0.71). Restricting comparisons to rural hospitals demonstrated a significant effect of rural hospital closures as compared to other rural counties (ARR = 0.119, p = 0.04). There was so significant effect in comparison of non-rural counties with hospital closures. Conclusions: These results demonstrate the disproportionate impact of hospital closure on rural health outcomes. As compared to patient-level analysis relying on hospital discharge data, this country level analysis captures non-hospital deaths and elucidates the true human cost of hospital closure.