Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal. Researchers at the North Carolina Rural Health Research and Policy Analysis Center found that closures were more likely to occur in a county with more non-white residents. Between 1990 and 2020, rural closure counties became more economically unequal, with higher unemployment, lower per capita income, and lower median household incomes compared with rural counties overall.