Impact of Community Health Center Losses on County-Level Mortality: A Natural Experiment in the United States, 2011–2019

IF 3.2 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2025-05-22 DOI:10.1111/1475-6773.14648

Sanjay Basu, Robert Phillips, Hank Hoang

{"title":"Impact of Community Health Center Losses on County-Level Mortality: A Natural Experiment in the United States, 2011–2019","authors":"Sanjay Basu, Robert Phillips, Hank Hoang","doi":"10.1111/1475-6773.14648","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To estimate the effect of Community Health Center (CHC) site losses on county-level mortality rates.</p>\n </section>\n \n <section>\n \n <h3> Study Setting and Design</h3>\n \n <p>We conducted a natural experiment study using difference-in-differences analysis of propensity score–matched US counties from 2011 through 2019.</p>\n </section>\n \n <section>\n \n <h3> Data Sources and Analytic Sample</h3>\n \n <p>The study included 3142 US counties, with 177 counties experiencing CHC site losses in 2014, per data from the health resources and services administration.</p>\n </section>\n \n <section>\n \n <h3> Principal Findings</h3>\n \n <p>Loss of CHC sites was associated with an increase in age-adjusted all-cause mortality of 3.54 deaths per 100 000 population (95% CI: 1.19, 5.90; <i>p</i> = 0.003) in the year following the loss. The largest increase was observed for cancer mortality (2.61 per 100 000; 95% CI: 0.59, 4.62; <i>p</i> = 0.011). Primary care physician density and patient volume loss both mediated the relationship.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>CHC site losses were associated with increases in mortality. Preserving CHC access may be important for maintaining population health, particularly in underserved areas.</p>\n </section>\n </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"60 5","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Services Research","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14648","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To estimate the effect of Community Health Center (CHC) site losses on county-level mortality rates.

Study Setting and Design

We conducted a natural experiment study using difference-in-differences analysis of propensity score–matched US counties from 2011 through 2019.

Data Sources and Analytic Sample

The study included 3142 US counties, with 177 counties experiencing CHC site losses in 2014, per data from the health resources and services administration.

Principal Findings

Loss of CHC sites was associated with an increase in age-adjusted all-cause mortality of 3.54 deaths per 100 000 population (95% CI: 1.19, 5.90; p = 0.003) in the year following the loss. The largest increase was observed for cancer mortality (2.61 per 100 000; 95% CI: 0.59, 4.62; p = 0.011). Primary care physician density and patient volume loss both mediated the relationship.

Conclusions

CHC site losses were associated with increases in mortality. Preserving CHC access may be important for maintaining population health, particularly in underserved areas.

Abstract Image

查看原文本刊更多论文

社区卫生中心损失对县级死亡率的影响：2011-2019年美国自然实验

目的：评估社区卫生中心（CHC）站点损失对县级死亡率的影响。研究设置和设计：我们对2011年至2019年倾向得分匹配的美国县进行了一项自然实验研究。数据来源和分析样本：根据卫生资源和服务管理局的数据，该研究包括3142个美国县，其中177个县在2014年经历了CHC站点的损失。主要发现：CHC位点的丧失与年龄调整后的全因死亡率增加相关，每10万人中有3.54人死亡(95% CI: 1.19, 5.90；P = 0.003)。癌症死亡率增幅最大(每10万人中有2.61人；95% ci: 0.59, 4.62；p = 0.011)。初级保健医生密度和病人体积损失都介导了这种关系。结论：CHC部位损失与死亡率增加有关。保持卫生保健服务的可及性对于维持人口健康可能很重要，特别是在服务不足的地区。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.