Hospitals in cities closed at nearly the same rate as those in rural areas from 2010 to 2025, with facilities serving poorer communities and places with fewer transportation options especially vulnerable, according to a study published Thursday in JAMA. Researchers at Harvard T.H. Chan School of Public Health counted 432 hospital closures and 216 openings over the 15-year period, leaving a net loss of more than 24,000 beds. Closures rose by an average of 4% a year, while openings fell by 3% annually, the researchers found. The closure rate was 9.1% among urban hospitals and 8.3% among rural hospitals. For-profit, small and safety-net hospitals were more likely to close, as were facilities serving counties with higher poverty rates or less access to transportation. About 73% of the hospitals that closed shut down completely. The rest continued to provide some outpatient services, including care through the rural emergency hospital model. New hospitals were mostly urban, for-profit and small, leaving rural areas less likely to gain replacement facilities. The Midwest and South recorded the most closures. The study also found more closures in states that had not expanded Medicaid eligibility under the Affordable Care Act. The findings come as health systems prepare for federal policy changes that could further strain access to care. The tax and spending law signed by President Donald Trump in July 2025 is projected by the Congressional Budget Office to reduce federal Medicaid spending by $886.8 billion over the next decade. The law also provides $50 billion in rural health grants to states over five years. The funding can support a range of initiatives, but rules limit how much hospitals can receive, according to an analysis by KFF. The researchers’ findings suggest that hospital access is not only a rural concern: Urban facilities also face significant closure risks, particularly when they serve communities with greater economic and transportation barriers.