LINCOLN, Neb. (AP) — A new study says the death rates in small rural hospitals are worse than at most hospitals. The study published in the Journal of the American Medical Association notes that the death rate in remote hospitals got worse between 2002 and 2010. The death rate at other hospitals improved over that same time period. Nebraska, Iowa, Minnesota, Texas and Kansas are the states with the most critical-access hospitals.

Nebraska has 65 of the smaller, rural hospitals that qualify for special treatment from Medicare because they provide critical access to care. The study’s lead author, Doctor Karen Joynt, says it may be harder for rural hospitals to afford the latest technology and advancements that are helping other hospitals.