JMIR Publications

ABSTRACT

Background:

Despite considerable efforts to encourage telehealth use during the coronavirus pandemic of 2019, we witnessed a potential widening of health inequities that may continue to plague the United States healthcare system unless we mitigate modifiable risk factors.

Objective:

The aim of the study was to examine the use of telehealth services among racial and ethnic minority groups whose annual incomes were below 200% of the federal poverty level.

Methods:

A retrospective observational study was performed using the COVID-19 Research Database to analyze factors that contributed to telehealth inequities. The study period was from March 2020 to April 2021. The Office Ally database provided United States claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore consumer database is a national representation of 242.5 million adults, in the United States, aged 19 and older. We analyzed medical claims to investigate the influence of demographic and socio-economic factors on telehealth utilization among the low-income, minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in different groups using telehealth during the study period.

Results:

Among the 2,850,831 unique patients, nearly 60% were female, 75% had a high school education or less, 49% were unemployed and 62% identified as Non-Hispanic White. Results suggest that 9.8% of the patients had one or more telehealth claims during the study period. Results also suggest that Asian (OR=1.569, 95% CI 1.528, 1.611, P<0.01) and Hispanic (OR=1.612, 95% CI 1.596, 1.628, P<0.01) patients are more likely to use telehealth than Non-Hispanic White patients and Non-Hispanic Black patients. Patients who identified as male are 12% (OR=0.875, 95% CI 0.867, 0.883, P<0.01) less likely to use telehealth than patients who identified as female. Patients with high school or less education are 5% (OR=0.953, 95% CI 0.944, 0.962, P<0.01) less likely to utilize telehealth as referenced to patients with Bachelor or higher education. Patients in the age group of 18-44 are 32% (OR=1.324, 95% CI 1.304, 1.345, P<0.01) more likely to use telehealth than patients in the 65+ age group.

Conclusions:

Low-income, minority communities are at greater risk for health inequities due to the barriers such as lack of resources and access to the healthcare system that were not overcome by these initiatives. Due to the long-standing challenges in the healthcare system, inequities have the potential to become entrenched in our society unless we take decisive action to address these challenges. As we seek to promote telehealth utilization, it is imperative that we consider the socio-economic and demographics. Clinical Trial: NA