The Financial Distress Index is an algorithm that uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress. A previous brief described the results that found disparities in certain characteristics of communities served by all rural hospitals at high risk of financial distress compared to those served by hospitals that were not at high risk of financial distress. The purpose of this brief is to use updated results from the FDI to compare the characteristics of communities served by CAHs at high risk of financial distress to those served by CAHs that are not at high risk of financial distress in 2019. In comparison to other CAHs, CAHs predicted to be at high risk of financial distress in 2019 serve communities that have significantly:

• Higher percentages of non-Whites and Blacks in particular
• Lower rates of high school graduation
• Higher rates of unemployment
• Worse health status as measured by percentage of obese adults, tobacco using adults, self-rated health of fair or poor, and number of premature deaths.