Hospital closures have affected urban communities nearly as often as rural ones, with the greatest risks falling on facilities serving people with fewer economic and transportation resources, a study published Thursday in JAMA found. Researchers at Harvard T.H. Chan School of Public Health examined hospital openings and closures from 2010 through 2025. They found that 9.1% of urban hospitals and 8.3% of rural hospitals closed during that period. In all, 432 hospitals shut down while 216 opened, producing a net loss of more than 24,000 hospital beds. Closures rose by an average of 4% year over year, while openings fell by 3%, the researchers reported. Small, for-profit and safety-net hospitals were especially likely to close. Risk was also higher for hospitals serving counties with higher poverty rates or less access to transportation. About 73% of the closed hospitals ceased operating entirely; others continued to provide some outpatient services, including care through the rural emergency hospital model. The Midwest and South recorded the most closures. States that did not expand Medicaid eligibility under the Affordable Care Act also had more closures, according to the study. The findings challenge the focus on rural hospitals alone: urban facilities, too, have been vulnerable, while rural areas are less likely to gain replacement hospitals. New facilities were more often urban, for-profit and small. The results come as health systems prepare for changes under the federal tax and spending law enacted in July 2025. The Congressional Budget Office estimates the law will reduce federal Medicaid spending by $886.8 billion over the next decade. It also sets aside $50 billion in rural health grants over five years, but the money is designated for a broad range of initiatives, and hospitals may face limits on how much they can receive. The study points to the potential consequences for communities that already have fewer doctors and fewer health care options. When a hospital closes, residents may face longer trips for care; the researchers’ findings suggest that vulnerability is not confined to rural areas.