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The Journal of Rural Health
Article . 2025 . Peer-reviewed
License: CC BY
Data sources: Crossref
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PubMed Central
Article . 2025
License: CC BY
Data sources: PubMed Central
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A novel approach to incorporate frontier areas into urban–rural geographic classifications: Integrated Metropolitan‐to‐Frontier Area Codes

Authors: Brody J. Gibson; Elizabeth Dobis; John Cromartie; Laurie Grieshober; Cornelia Ulrich; Tracy Onega; Jennifer Doherty;

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

Abstract

Abstract 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 tIMFAC metropolitan, micropolitan, and small town/rural categories had higher population densities (312, 74, and 27/m 2 , respectively) than their RUCA counterparts (304, 54, and 11/m 2 , respectively). Densities were much lower in tIMFAC frontier–micropolitan and frontier–small town/rural areas (23 and 4/m 2 , 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.

Keywords

Rural Population, Urban Population, Humans, Original Article, Health Services Accessibility, United States

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
2
Top 10%
Average
Average
Green
hybrid