Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska 68198-4350, USA.
J Rural Health. 2013 Jun;29(3):258-65. doi: 10.1111/j.1748-0361.2012.00451.x. Epub 2013 Jan 15.
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.
本横断面描述性研究旨在考察和比较美国边境县和非边境县的县一级特征，包括人口因素、卫生系统因素和人群健康结果。使用合并的 2011 年县健康排名数据库和 2009 年区域资源文件数据库，对美国所有县进行了研究。在 2011 年县健康排名数据库中共有 3141 个县，其中 438 个县被确定为边境县，采用的是每平方英里人口少于 7 人的传统定义。
与非边境县相比，边境县的老年人口、西班牙裔人口和美国原住民人口比例明显较高。边境县的家庭收入较低，文盲率较低。边境县的初级保健医生也明显较少，未参保率较高。尽管边境县的邮政编码拥有健康食品和娱乐设施的比例较低，但边境地区的肥胖发病率较低。
关于边境地区人群健康结果和卫生系统因素的实证文献有限。美国边境社区在满足对初级保健需求较高的人群（如老年人和穷人）方面面临重大挑战。此外，由于地理位置偏远，他们还面临着获得医疗服务的障碍。获得可靠的人口结果数据将使政策制定者能够监测边境人群的健康状况，并设计解决这些人群所面临的获取医疗服务问题的方案。
