Impact of Rural Hospital Closures on Survival Among Medicare Beneficiaries Diagnosed With Colorectal, Lung, Breast, and Prostate Cancer.

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 uses 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 living 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: A total of 33,716 cancer patients were included. Cox proportional hazards analyses revealed significantly higher all-cause mortality among colorectal cancer patients living in counties that experienced rural hospital closures (HR = 1.139, 95% CI: 1.030-1.259), but no significant difference was observed among those living in control counties, after adjusting for covariates. 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.

CONCLUSIONS

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.