Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 16, 2025
Date Accepted: Sep 25, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Equity Imperative in Digital Health: Intersectional Analysis of Telehealth Utilization Patterns and Their Health Outcome Implications
ABSTRACT
Background:
Telehealth has emerged as a transformative approach to healthcare delivery, particularly accelerated by the COVID-19 pandemic. Although telehealth has been shown to improve access to healthcare services and reduce healthcare disparities, there is mounting evidence that telehealth consumption patterns may mirror and even exacerbate pre-existing healthcare disparities.
Objective:
To examine health equity considerations in telehealth utilization, with particular focus on the intersections between various sociodemographic characteristics, including ethnic background, geographic location, and socioeconomic status.
Methods:
We conducted a retrospective analysis of health and administrative data from 499,607 adult members of Clalit Health Services in Israel's Sharon-Shomron District across three time periods: pre-COVID (2019-2020), COVID (2020-2021), and post-COVID (2021-2022). Telehealth utilization patterns were analyzed by sociodemographic characteristics using descriptive statistics and multivariable logistic regression.
Results:
Overall telehealth utilization more than doubled from pre-COVID (4.06%) to post-COVID (9.38%). Significant disparities were observed across multiple dimensions: younger adults (25-35 years) utilized telehealth at triple the rate of older adults (≥70 years); women demonstrated consistently higher usage than men; high socioeconomic status members used telehealth at nearly four times the rate of those of low socioeconomic status; and religious Jewish sector members showed nearly ten times higher utilization than Arab/Bedouin sector members. A U-shaped relationship with peripherality was observed, with both very peripheral and very central locations demonstrating higher utilization than intermediate areas. After-hours telehealth usage declined from 65% pre-COVID to 49% post-COVID, indicating telehealth's evolution from an after-hours alternative to an integrated component of regular healthcare delivery.
Conclusions:
Telehealth expansion benefits have not been equally distributed across all population segments. Nonetheless, telehealth is disproportionately positively utilized among some minority groups. Addressing identified disparities through targeted interventions is crucial to ensuring digital health advances promote rather than exacerbate healthcare equity. Strategic approaches should include culturally-appropriate outreach, technology access programs, inclusive design principles, and multi-modal delivery methods to reach diverse populations.
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