{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:07Z","timestamp":1789995727243,"version":"4.0.1"},"reference-count":46,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":37,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["RP210130"],"award-info":[{"award-number":["RP210130"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To examine the impact of rural hospital closures on mortality among patients with colorectal, lung, breast, and prostate cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational cohort study uses SEER\u2010Medicare linkage data from 2000\u20132020 to evaluate all\u2010cause and cancer\u2010specific 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\u2010matched rural counties with sustained hospital access. The primary outcomes were all\u2010cause and cancer\u2010specific mortality among patients with colorectal, lung, breast, and prostate cancer.\u00a0Analyses compared outcomes before and after rural hospital closures and between rural counties with and without closures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>A total of 33,716 cancer patients were included. Cox proportional hazards analyses revealed significantly higher all\u2010cause mortality among colorectal cancer patients living in counties that experienced rural hospital closures (HR = 1.139, 95% CI: 1.030\u20131.259), but no significant difference was observed among those living in control counties, after adjusting for covariates. For lung cancer patients, significantly lower cancer\u2010specific mortality was observed in control counties during the post\u2010closure period (HR = 0.906, 95% CI: 0.834\u20130.983), with no significant difference in the closure group. No significant effects were found for breast or prostate cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70148","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T06:50:26Z","timestamp":1775631026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Rural Hospital Closures on Survival Among Medicare Beneficiaries Diagnosed With Colorectal, Lung, Breast, and Prostate Cancer"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4210-8349","authenticated-orcid":false,"given":"Zhaoli","family":"Liu","sequence":"first","affiliation":[{"name":"College of Nursing and Health Innovation The University of Texas at Arlington  Arlington Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daoqi","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Data Science, School of Public and Population Health University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Martin","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Innovation The University of Texas at Arlington  Arlington Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhonda","family":"Winegar","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Innovation The University of Texas at Arlington  Arlington Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon H.","family":"Giordano","sequence":"additional","affiliation":[{"name":"Departments of Breast Medical Oncology and Health Services Research, MD Anderson Cancer Center The University of Texas  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong\u2010Fang","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Data Science, School of Public and Population Health University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"U.S. Department of Health and Human Services. \u201cDefining Rural Population | Guidance Portal.\u201d Accessed August 21 2023.https:\/\/www.hhs.gov\/guidance\/document\/defining\u2010rural\u2010population."},{"key":"e_1_2_10_3_1","unstructured":"Assistant Secretary for Planning and Evaluation. \u201cOffice of Health Policy: National Uninsured Rate at 8.2 Percent in the First Quarter of 2024.\u201d Published online August 2024. 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Rural Hospital Closures.\u201dSheps Center. Accessed April 22 2023.https:\/\/www.shepscenter.unc.edu\/programs\u2010projects\/rural\u2010health\/rural\u2010hospital\u2010closures\/."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003366"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13988"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12716"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00916"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13965"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2020.05.009"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12658"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32594"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.20.00352"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21871"},{"key":"e_1_2_10_19_1","unstructured":"Rural Hospital Closures. \u201cSheps Center.\u201d Accessed February 7 2023.https:\/\/www.shepscenter.unc.edu\/programs\u2010projects\/rural\u2010health\/rural\u2010hospital\u2010closures\/."},{"key":"e_1_2_10_20_1","unstructured":"U.S. Department of Agriculture. \u201cUSDA Rural\u2010Urban Continuum Codes.\u201d Accessed March 25 2023.https:\/\/www.ers.usda.gov\/data\u2010products\/rural\u2010urban\u2010continuum\u2010codes.aspx."},{"key":"e_1_2_10_21_1","unstructured":"National Cancer Institute. \u201cSEER\u2010Medicare Linked Data Resource.\u201d Accessed June 26 2023.https:\/\/healthcaredelivery.cancer.gov\/seermedicare\/."},{"key":"e_1_2_10_22_1","unstructured":"US Census Bureau. \u201cAmerican Community Survey (ACS) 2014\u2014Census Bureau Search.\u201d Accessed April 11 2023.https:\/\/data.census.gov\/all?q=American+Community+Survey+(ACS)+2014."},{"key":"e_1_2_10_23_1","unstructured":"\u201cICD\u20109 SEER Cause\u2010Specific Death for Sequence 00\u2014SEER Recodes.\u201d Accessed May 25 2023.https:\/\/seer.cancer.gov\/causespecific\/icd9seq00.html."},{"key":"e_1_2_10_24_1","unstructured":"Health Resources and Services Administration.List of Rural Counties and Designated Eligible Census Tracts in Metropolitan Counties. 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