PROJECT SUMMARY/ABSTRACT
Since 2005, 199 rural hospitals have closed in the US. These closures have resulted in a loss of primary care
physicians, surgical services, limited access to care, preventive services, and treatments, leading to poor
outcomes for rural populations. However, the impact of rural hospital closures on cancer outcomes remains
largely unknown. Recent studies indicate that rural-urban disparities in cancer care are widening, especially
among racial/ethnic minority populations. This disparity could be attributed to the closure of rural hospitals over
the last few decades. There is a limited understanding of the impact of these closures on cancer outcomes and
racial disparities among rural cancer survivors. To address this gap, we propose a systematic examination of
the impact of rural hospital closures on rural cancer survivors among Medicare beneficiaries diagnosed with
lung, breast, prostate, and colorectal cancers. The objective of this study is to investigate how rural hospital
closures affect cancer outcomes from screening to survivorship and impact racial/ethnic disparities. We will
employ a difference-in-differences methodology to conduct this retrospective longitudinal study using
Surveillance, Epidemiology, and End Results (SEER) and Medicare linkage data from 2000-2019. We
hypothesize that rural counties experiencing hospital closures will exhibit greater disparities in cancer care
continuum than those without rural hospital closures. Therefore, the study's specific aims are to: (1) assess the
effects of rural hospital closures on cancer screening, diagnosis, treatment, mortality, and survivorship care in
rural counties, and (2) examine the impact of hospital closures on minority populations and identify mediators
contributing to these disparities. The findings will help bridge the gap in rural cancer care and guide healthcare
professionals and policymakers in allocating resources for rural hospitals more effectively. Additionally, this study
will provide foundational evidence for the development of alternative medical care services tailored to rural
communities. Ultimately, this research aims to optimize healthcare services for rural cancer survivors and reduce
racial and ethnic disparities associated with rural hospital closures.