Neighbourhood church closures and self-rated health in Southeastern Pennsylvania: a population-based study.

BACKGROUND: Religious and faith-based institutions play a critical role in the social infrastructure that supports population health. While prior research has focused largely on individual religious participation or the presence of congregations within neighbourhoods, far less is known about the population health implications when places of worship close within communities. In this study, we examine church closures as a novel neighbourhood-level indicator and its association with self-rated health (SRH). METHODS: We linked 2015 and 2018 Southeastern Pennsylvania Household Health Survey individual SRH data (n=16 294 adults) across 219 ZIP Code Tabulation Areas to churches that closed between 2009 and 2014. Church closure data were from Data Axle. Church closure density (closures/km²) was modelled using multilevel linear models and spline models, adjusting for individual sociodemographic factors and neighbourhood characteristics. RESULTS: Church closures were concentrated in socioeconomically disadvantaged neighbourhoods with higher proportions of racial/ethnic minority residents (58.6% below median income, Black: 36.0%). Spline regression models revealed significant non-linear associations. Across the lower range of closure density (below the -0.5 SD threshold, approximately the 53rd percentile), each SD increase in closure density was associated with a 0.385-point lower SRH score (95% CI -0.644 to -0.127) in the fully adjusted baseline-adjusted model. Above this threshold, the association was significantly attenuated (β=0.407, 95% CI 0.152 to 0.662), consistent with a near-null net effect in higher-closure-density areas. CONCLUSIONS: Neighbourhood church closures were associated with poorer SRH in specific contexts and can be considered an indicator of institutional loss.