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

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.