Who Loses Out? Evaluating the Association Between County Vulnerability and Closures of U.S. Hospitals, Emergency Departments, and Obstetrics Departments

Abstract

Over the past several years, hospital, emergency department, and obstetrics department closures have greatly impacted the hospital industry across the U.S. While current research documents the reasons why closures occur and how they may impact health care access and outcomes, there is a current gap in recent literature about the characteristics of the surrounding communities where closures occur. This thesis aims to answer the following question: What is the association between county demographics and closures of U.S. hospitals, emergency departments, and obstetrics departments? The analysis spans the years 2010-2019 and uses hospital data from the American Hospital Association’s Annual Surveys, county demographic data from the U.S. Census Bureau’s 5-year American Community Survey estimates, and county vulnerability data from the CDC/ATSDR 2019 Social Vulnerability Index. Results show substantial socioeconomic and racial disparities in counties that experienced closures of hospitals and emergency departments during this study’s 10-year time period, with fewer disparities in counties where obstetrics department closures occur. After controlling for socioeconomic factors, Hispanic race and Black race were significant in predicting the likelihood of a county experiencing a hospital or emergency department closure (positive association). Black race was also significantly associated with the likelihood of an obstetrics department closure (positive association). Ultimately, the findings from this thesis suggest that poorer communities and communities of color are disproportionately impacted by closures, and unless trends change or interventions are implemented, these communities may continue to face greater barriers to health care access in the future, as closures rise.