More than 100 rural hospitals have closed in the United States since 2010 and another 430 are at risk of closing, which a new study says could have life-or-death implications for rural communities.

University of Washington researchers examined 92 rural hospital closings in California from 1995 to 2011. They found that while the closings of urban hospitals had no impact on their surrounding communities, rural closings caused their populations — which have limited access to health care and other services — to see mortality rates rise 5.9 percent.

That could have real implications for communities across the United States given that 113 hospitals have already closed since 2010 and more face financial difficulties, according to data compiled by the University of North Carolina.

“Rural closings increase travel times for patients, and lead to outmigration of health care professionals post-closure, severely dismembering patient access to care and exacerbating social disparities in health outcomes,” researchers Kritee Gujral and Anirban Basu wrote in their study.

The distance that ambulances have to travel to patients after a hospitals closes, as well as the limited number of ambulances in rural counties, means that residents there may have to wait for care after a car accident, heart attack or other health emergency, Dr. Nancy Dickey, president of the Rural and Community Health Institute at Texas A&M, said.

"There’s a golden hour of getting care in that first hour of trauma," Dickey said. "If you don't get care in that time, it can have a negative impact on morbidity as well as mortality."

Rural residents also often lack health insurance while their communities struggle with deteriorating hospitals and recruiting physicians, said George Pink, deputy director of the Rural Health Research Program at the University of North Carolina's Sheps Center. He added that many rural hospitals carry high financial burdens and the communities themselves are declining in population.

The population in nonmetro counties decreased by 200,000 people from 2010 to 2016, the National Advisory Committee on Rural Health and Human Services found, the first such loss ever recorded.

“These problems are exacerbated in rural areas, especially due to the recent economic downturns and job losses leading to outmigration and shrinking populations, leaving behind populations that are older, sicker and more reliant on Medicaid and Medicare,” the researchers wrote.

It’s also an issue that some believe is exacerbated in the 14 states that have refused to expand Medicaid — a perspective supported by a January 2018 study from the University of Colorado.

Researchers there studied hospitals' financial health and closings from 2008 to 2016 and concluded that hospitals in states that did not expand Medicaid saw a sharp increase of hospital closings, while states that expanded Medicaid saw closure rates decrease.