| Sumario: | Background & Significance: Since 2005, 196 rural hospital have closed. Rural hospital closures are associated with reductions in healthcare access. Theirs impact on rural cancer mortality remain unknown. Purpose: To examine the impact of rural hospital closures on mortality among patients with colorectal, lung, breast, and prostate cancer. Methods: This retrospective observational cohort study using SEER-Medicare linkage data from 2000-2020 to evaluate all-cause and cancer-specific mortality among Medicare beneficiaries diagnosed with colorectal, lung, breast, or prostate cancer. The closure group included patients residing in counties that experienced rural hospital closures; the control group consisted of patients from propensity score-matched rural counties with sustained hospital access. The primary outcomes were all-cause and cancer-specific mortality among patients with colorectal, lung, breast, and prostate cancer. Analyses compared outcomes before and after rural hospital closures and between rural counties with and without closures. Findings and Interpretations: A total of 33 716 cancer patients were included. Cox proportional hazards analyses revealed significantly higher all-cause mortality among colorectal cancer patients in counties after rural hospital closures (HR = 1.139, 95% CI: 1.030-1.259), but no significant difference in control counties, after adjusting for co-variates. For lung cancer patients, significantly lower cancer-specific mortality was observed in control counties during the post-closure period (HR = 0.906, 95% CI: 0.834-0.983), with no significant difference in the closure group. No significant effects were found for breast or prostate cancer patients. Discussion: Rural hospital closures are associated with worse survival outcomes for colorectal and lung cancer patients but not for breast or prostate cancer patients. Targeted policy interventions are needed to mitigate the adverse effects of hospital closures on cancer care in rural communities.
|
|---|