Acknowledgment: The authors would like to acknowledge Nicole Vanosdel, MPA, Health Data Analyst, Department of Health Services Research and Administration, University of Nebraska Medical Center, for the cartography for this study.
Frontier America's Health System Challenges and Population Health Outcomes
Article first published online: 15 JAN 2013
© 2013 National Rural Health Association
The Journal of Rural Health
Volume 29, Issue 3, pages 258–265, Summer 2013
How to Cite
Nayar, P., Yu, F. and Apenteng, B. A. (2013), Frontier America's Health System Challenges and Population Health Outcomes. The Journal of Rural Health, 29: 258–265. doi: 10.1111/j.1748-0361.2012.00451.x
- Issue published online: 26 JUN 2013
- Article first published online: 15 JAN 2013
- access to care;
- health system challenges;
- population health outcomes;
The objective of this cross-sectional descriptive study was to examine and compare the county-level characteristics including demographic factors, health system factors, and population health outcomes of frontier and nonfrontier counties in the United States. All counties in the United States were studied using the merged County Health Rankings 2011 and the Area Resource File 2009 databases. Of a total of 3,141 counties in the County Health Rankings 2011 database, 438 were identified as frontier counties using the conventional definition of fewer than 7 persons per square mile.
Frontier counties were found to have a significantly higher proportion of elderly, Hispanic, and Native American residents than nonfrontier counties. Frontier counties have lower household income and lower levels of illiteracy. Frontier counties also have significantly fewer primary care physicians and higher uninsurance rates. Although frontier counties have a lower percentage of ZIP codes with healthy food and recreational facilities, the incidence of obesity is lower in frontier areas.
Empirical literature on the population health outcomes and health system factors of frontier areas is limited. Frontier communities in the United States face significant challenges in terms of having populations with a higher need for primary care such as the elderly and poor. In addition, they face access barriers due to geographic remoteness. The availability of reliable data on population outcomes will enable policy makers to monitor the health status of frontier populations and to design solutions to the access issues that these populations face.