Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Nov 23, 2023)
Date Submitted: Dec 12, 2022
Open Peer Review Period: Dec 8, 2022 - Feb 2, 2023
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Rural Counties of the United States are Underrepresented in Measures of Consumer Broadband
ABSTRACT
Background:
Patients in rural and underserved communities lack access to specialty care, preventive care, and even emergency care. Telehealth has the potential to mitigate this lack of access; however, many telehealth services are only viable where broadband internet is available. Existing data sets measuring broadband access may underrepresent the state of broadband in rural and underserved communities
Objective:
We examined three consumer broadband data sets from two organizations to see if the number of user-generated internet speed tests per 1,000 residents varied across county-level rurality.
Methods:
We analyzed data at the county level from Measurement Labs and Ookla for Good (fixed and mobile) across calendar years 2020 and 2021. We used the number of tests conducted per 1,000 residents within United States counties as the outcome variable, and Rural-Urban Continuum Codes (RUCC) as the main independent variable of interest. Included covariates were year/quarter, percent non-Hispanic White, percent non-Hispanic Black or African-American, percent Hispanic, average household size, percent of adults with a high school diploma, unemployment rate, percent persons in poverty, percent population over 65 years of age, percent female, percent non-English-speaking household, and percent of households that have a computer and broadband connection.
Results:
Using OLS models with robust standard errors, we found the number of speed tests per 1,000 residents was smaller in counties with fewer than 20,000 residents relative to counties with over 1 million residents for all three data sources. However, patterns of association with other covariates emerged as significant in some models and not others, suggesting key differences among users generating speed tests in all three data sources.
Conclusions:
Our findings demonstrate a consistent underrepresentation of residents from very rural counties in three large, publicly available data sets of user-generated internet speed tests. Additional data collection is needed to inform broadband infrastructure investment to identify those communities most left behind by broadband expansion efforts.
Citation
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