Effects of hospital and obstetric unit closures on postpartum acute care across county racial composition in rural North Carolina

The Journal of Rural Health 2026

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Authors: Mekhala V. Dissanayake, John Wyse Jackson, Rachel Peragallo Urrutia, Chantel L. Martin, Michele Jönsson Funk, Mollie E. Wood
DOI: 10.1111/jrh.70114
Cited by: 1
References: 46

Abstract

PURPOSE: Hospital and obstetric unit closures are concentrated in the rural Southern United States, often where marginalized racial/ethnic groups reside and access to maternal health care is already strained. Given structural racism's role as a fundamental cause of inequities, we hypothesized that closure effects may vary by race and racial composition of county. METHODS: We used linked North Carolina birth certificates and Medicaid claims from births occurring to rural residents from 2014 to 2019. Using a Trial Emulation Policy Approach with a Difference-in-Difference analysis, we estimated the effects of hospital and obstetric closures on postpartum acute care (maternal emergency department visit or hospital admission) by race and county racial composition. We categorized rural counties as lower (LNHW,

Fields of Study & Subjects

Emergency and Acute Care Studies Maternal and fetal healthcare Maternal and Perinatal Health Interventions

Publication details

Journal / source
The Journal of Rural Health
Publisher
Wiley
Volume
42
Issue
1
Pages
e70114–e70114
Publication date
1 January 2026
Language
EN