Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 21, 2021
Date Accepted: Jun 23, 2021
Date Submitted to PubMed: Aug 3, 2021
Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-Sectional Study
ABSTRACT
Background:
The use of telemedicine outpatient visits has increased dramatically during the coronavirus disease 2019 (COVID-19) pandemic in many countries. Although disparities in access to telemedicine by age and socio-economic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic.
Objective:
To investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic.
Methods:
Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations between participants' ages and SES (educational attainment, urbanicity of residence, and income level) and their telemedicine use in two time periods during the pandemic: April and August-September 2020.
Results:
Of the 24,526 participants aged 18–79 years (50.8% [12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (497) in April to 4.7% (1,159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April. Although this pattern persisted in August-September, we also observed a substantial increase in telemedicine use among individuals aged 70-79 years (adjusted rates, 0.2% in April vs. 3.8% in August-September; P<.001 after multiple comparisons). We found disparities by SES in the use of telemedicine in August-September that did not exist in April. In August-September, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (6.6% vs. 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September (5.2% vs. 3.8%; P<.001). Disparities due to income level in telemedicine use were not observed in either time period.
Conclusions:
In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities by educational attainment and urbanicity of residence in the use of telemedicine widened during the COVID-19 pandemic.
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