JMIR Publications

JMIR Preprints


Currently submitted to: Journal of Medical Internet Research

Date Submitted: Aug 28, 2017
Open Peer Review Period: Aug 29, 2017 - Oct 24, 2017

NOTE: This is an unreviewed Preprint

Peer-Review Me

Usage of a Digital Health Workplace Intervention based on Socioeconomic Environment and Race: Is there a Digital Divide?

  • Amir Lerman; 
  • Conor Senecal; 
  • Robert Jay Widmer; 
  • Kent Baily; 
  • Lilach O Lerman



Digital health tools have been associated with improvement of cardiovascular (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes in not well known.


To identify the effect of socioeconomic environment of usage of a digital health intervention.


We analyzed usage of a previously-validated workplace digital health tool in association with a change in intermediate markers of CVD over the course of one year in 26,188 participants of a work health program across 81 organizations in 42 states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and HbA1c which was then obtained in 90 day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. DHI usage was analyzed based on socioeconomic status as well as age, gender, and race.


The cohort was found to represent a wide sample of socioeconomic environments from a median income of $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Blacks showed a 40.5% increase and Hispanics showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasians.


The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and DHI usage for Whites. However, a strong relationship is present for Black and Hispanic cohorts. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for cardiovascular disease. This identifies a need for digital health applications that are effective in these high risk groups.


Retrospective analysis, no trial number