Associations of U.S. hospital closure (2007-2018) with area socioeconomic disadvantage and racial/ethnic composition.

Purpose: To examine whether hospital closure is associated with high levels of area socioeconomic disadvantage and racial/ethnic minority composition.
Methods: Pooled cross-sectional analysis (2007-2018) of 6467 U.S. hospitals from the American Hospital Association's Annual Survey, comparing hospital population characteristics of closed hospitals to all remaining open hospitals. We used multilevel mixed-effects logistic regression models to assess closure as a function of population characteristics, including area deprivation index ([ADI], a composite measure of socioeconomic disadvantage), racial/ethnic composition, and rural classification, nesting hospitals within hospital service areas (HSAs) and hospital referral regions. Secondary analyses examined public or private hospital type.
Results: Overall, 326 (5.0%) of 6467 U.S. hospitals closed during the study period. In multivariable models, hospitals in HSAs with a higher burden of socioeconomic disadvantage (per 10% above median ADI ZIP codes, AOR 1.05; 95% CI, 1.01-1.09) and Black Non-Hispanic composition (highest quartile, AOR 4.03; 95% CI, 2.62-6.21) had higher odds of closure. We did not observe disparities in closure by Hispanic/Latino composition or rurality. Disparities persisted for Black Non-Hispanic communities, even among HSAs with the lowest burden of disadvantage.
Conclusions: Disproportionate hospital closure in communities with higher socioeconomic disadvantage and Black racial composition raises concerns about unequal loss of healthcare resources in the U.S.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tung reports financial support was provided by National Heart Lung and Blood Institute. Huang, Chin, Tung and Peek reports financial support was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Huang reports financial support was provided by National Institute on Minority Health and Health Disparities. Huang reports financial support was provided by National Institute on Aging. Chin and Peek reports financial support was provided by KAISER FOUNDATION HEALTH PLAN. Dr. Chin was a consultant to the Patient-Centered Outcomes Research Institute on health equity, and is a lead subject matter expert to the Agency for Healthcare Research and Quality for health equity research. Dr. Chin co-chairs the Centers for Medicare & Medicaid Services Health Care Payment Learning and Action Network Health Equity Advisory Team. Dr. Chin is a member of the Bristol-Myers Squibb Company Health Equity Advisory Board and Blue Cross Blue Shield Health Equity Advisory Panel. Dr. Chin was a member of the NIMHD National Advisory Council and the NIDDK Health Disparities and Health Equity Working Group of Council. Dr. Peek was a consultant to the Patient-Centered Outcomes Research Institute on health equity, and is a subject matter expert to the Agency for Healthcare Research and Quality for health equity research. She is a Senior Associate Editor at the journal Health Services Research which is funded by the American Hospital Association.
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