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Study Links Health Center Closures to Higher County Mortality Rates

Federally qualified health centers provide primary care, dental services, behavioral health care, and other medical and social services to more than 30 million people living in the United States, regardless of a patient’s ability to pay. Direct Relief supports them with medical aid and financial support to reach patients.

News

United States

Raed Ahmed measures out medication at the Saban Community Clinic in LA. (Noah Smith/Direct Relief)
By Noah Smith

The loss of Community Health Center, or CHC, sites in the United States is associated with a significant increase in county-level mortality, particularly in underserved areas, according to a new national study.

The peer-reviewed study, which was published in April 2025 in Health Services Research, analyzed data from 3,142 U.S. counties between 2011 and 2019, and found that counties that lost CHC sites in 2014 experienced an average increase of 3.54 age-adjusted all-cause deaths per 100,000 residents in the year following the loss. This increase was most pronounced in cancer-related deaths, which rose by 2.61 deaths per 100,000 residents. The closures appeared to have a lasting impact in the years that followed, according to the researchers.

Beyond CHC closures, the authors, Dr. Sanjay Basu, Dr. Robert Phillips, and Hank Hoang, a pharmacist, all of whom work in a CHC or CHC-supporting setting, found that both decreased primary care physician density and patient volume were linked to the increase in mortality. When CHC sites closed, not only did counties retain fewer doctors, but they also saw fewer patients accessing care, two factors associated with declining health outcomes.

Detroiter Eric Walker and Dr. Jamie Hall after their appointment at CHASS, a federally qualified health center in Detroit. (Noah Smith/Direct Relief)

Counties that lost CHC sites in 2014 had higher rates of children in poverty, unemployment, and violent crime compared to counties that retained them. The analysis controlled for these factors as well as overall poverty rates, education levels, and air pollution. They checked and confirmed that both populations, namely counties with and without clinic closures, were following similar trends before the closures happened. This made it more likely that any differences seen afterward were caused by the closures as opposed to other factors.

Community Health Centers, some of which are designated as federally qualified health centers, or FQHCs, provide primary care, dental services, behavioral health care, and other medical and social services to more than 30 million people living in the United States, including about 1 in 5 people living in rural areas, regardless of a patient’s ability to pay.

Their role has been critical in counties with high poverty, unemployment, and limited access to other providers. They have also helped to fill gaps in higher-income areas where residents, for example, might fall into a gap where they earn too much to qualify for safety net health insurance but cannot afford private plans or plans with high co-payments or deductibles.

Across the U.S. in 2014, 177 counties had a net loss of CHCs while 152 counties gained sites, according to data from the Health Resources and Services Administration. The vast majority of counties had no change.

The researchers noted limitations such as unmeasured variables, including local hospital closures, consolidation of healthcare systems, major employer exits, the quality of care at remaining facilities, or local policy changes.

Ryan Health’s Chelsea-Clinton branch in Hell’s Kitchen, New York City. More than 80 percent of the health center’s patients earn an income below the federal poverty line. (Noah Smith/Direct Relief)

These latest findings add to a growing body of research pointing to the benefits of community health centers in treating specific conditions. National studies have previously linked regular care at CHCs to fewer emergency room visits. In the U.S. South, greater access to federally qualified health centers has been tied to fewer late HIV diagnoses and higher rates of viral suppression. One study, however, found Medicaid patients at CHCs performed slightly worse on some diabetes care process measures, though they were less likely to be hospitalized.

The authors say the findings and the reasons behind why CHCs have been closed should inform future health policy debates, especially as some states weigh funding cuts to safety-net providers.

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