A novel approach to incorporate frontier areas into urban–rural geographic classifications: Integrated Metropolitan‐to‐Frontier Area Codes

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PURPOSE: To develop an urban-rural-frontier classification that integrates urbanicity and geographic remoteness and captures nuances in population and land area distributions invisible in traditional coding schemes, thereby providing a framework to measure health outcomes and access to care across the full urban-to-frontier continuum. METHODS: We created tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) by combining the US Department of Agriculture's Economic Research Service's Frontier and Remote Area (FAR) codes with Rural-Urban Commuting Area (RUCA) codes, classifying tracts as metropolitan, micropolitan, frontier-micropolitan, small town/rural, and frontier-small town/rural. We compared population and land area distributions and median distances to health care facility types by RUCA, FAR, and tIMFAC, and summarized distances to health care facilities across tIMFAC by Census regions. FINDINGS: , respectively) than micropolitan and small town/rural. Three patterns emerged for travel distances across tIMFAC: (1) steadily increasing distances from metropolitan to frontier-small town/rural areas (e.g., medical-surgical intensive care units (ICUs)); (2) similar distances within frontier-micropolitan and micropolitan, and within frontier-small town/rural and small town/rural, respectively (e.g., obstetrics); and (3) longer distances for frontier areas regardless of urbanicity (e.g., pediatric ICUs and designated trauma centers). CONCLUSION: tIMFAC provides a policy-relevant approach to identifying health differences across the urban-to-frontier continuum, supporting efforts to better understand and address unique rural and frontier health challenges.

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