Hospital Closures Increase Emergency Care Travel Time: Rural-Urban Disparities

Travel time is a key factor for emergency care access and outcome, especially in traumatic or time-sensitive injuries. Hospital closures can lead to the shutdown of the emergency departments (EDs), which cut emergency care service for the population they previously served. This study aimed to evaluate how hospital closures were associated with likelihood and magnitude of travel time increase to emergency departments in Texas by Rural-Urban Commuting Area (RUCA) categories (Metropolitan, Micropolitan, Small Town and Rural). We obtained the 2023 list of licensed Texas hospitals and identified hospital closures back to 2012. Travel time and distance to the nearest and second nearest emergency departments were calculated by ArcGIS Pro 3.2 and the Network Analysis extension based on 2020 U.S. Census. We used logistic and OLS regressions with geographic categories, baseline travel time, and socioeconomics covariates at the census tract level. Among a total of 6,883 census tracts, 135 experienced travel time increase to the nearest ED and 263 to the second nearest ED. Compared with Metropolitan areas, Micropolitan, Small Town and Rural areas have a higher predicted probability of experiencing travel time increase. Among affected census tracts, travel time increased by 3.83 minutes in Micropolitan area, 5.04 minutes in Small Town area, and 2.67 minutes in Rural area to the nearest ED compared with Metropolitan area (statistically significant except Rural). Compared with Metropolitan area, traveling to the second nearest ED increased 2.43, 4.60 and 1.95 minutes, respectively (all statistically significant). Our findings suggest that hospital closures have a disproportionate burden on rural communities than urban communities.