Impact of Community Health Center Losses on County‐Level Mortality: A Natural Experiment in the United States, 2011–2019
研究美国2011-2019年社区卫生中心关闭对县级死亡率的影响，发现关闭后全因死亡率每10万人增加3.54例，癌症死亡率增加2.61例，对政策制定者评估基层医疗资源有参考价值。
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.