Geographic, racial/ethnic, and socioeconomic inequities in broadband access

Abstract

Introduction Broadband access is a “super determinant of health.” Understanding the spatial distribution and predictors of access may help target government programs and telehealth applications. Our aim was to examine broadband access across geography and sociodemographic characteristics using American Community Survey (ACS) data. Methods We used 5‐year ACS estimates from 2014 to 2018 to evaluate broadband access across contiguous US census tracts. Rural‐Urban Commuting Area (RUCA) codes were categorized as metropolitan, micropolitan, small town, and isolated rural. We performed bivariate analyses to determine differences by RUCA categories and meeting the Healthy People 2020 (HP2020) objective (83.2% broadband access) or not. We conducted spatial statistics and spatial regression analyses to identify clusters of broadband access and sociodemographic factors associated with broadband access. Results No RUCA grouping met the HP2020 objective; 80.6% of households had broadband access, including 82.0% of metropolitan, 73.9% of micropolitan, 70.7% of small town, and 70.0% of isolated rural households. Areas with high percentages of Black residents had lower broadband access, particularly in isolated rural tracts (54.9%). Low access was spatially clustered in the Southeast, Southwest, and northern plains. In spatial regression models, poverty and education were most strongly associated with broadband access, while the proportion of American Indian/Alaska Native population was the strongest racial/ethnic factor. Conclusions Rural areas had less broadband access with the greatest disparities experienced among geographically isolated areas with larger Black and American Indian/Alaska Native populations, more poverty, and lower educational attainment, following well‐known social gradients in health. Resources and initiatives should target these areas of greatest need.

Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study

“…Similar international studies [41,42] have reported on broadband access challenges with telehealth programs for both rural and underserved populations. The shift to internet-based health consultations and associated increased reliance on internet connections because of the impact of the COVID-19 pandemic have further negatively affected telehealth use for those with existing health disparities.…”

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study

“…Existing health and technological disparities became more apparent during COVID-19 [101,102], and future studies are needed to better understand the relationship between the services offered and the needs and abilities of patients and providers. For example, the lack of access to adequate devices and Wi-Fi resources for VCVs is well documented [1,103,104], but the impact of other factors, such as language barriers and availability of privacy and safe spaces for VCVs [105], require better understanding and accommodation. Specifically in relationship to rapport, there is some evidence that qualitative differences between type of device, strength of broadband, and level of literacy impact the level and quality of empathetic communication within VCVs [92].…”

Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics

“…In addition, increased availability of online interventions due to the SARS-CoV-2 pandemic may allow for penetration of evidence-based programs in rural areas. However, access to broadband internet and internet-capable devises still lags in many rural communities (49), which may ultimately limit the utility of online treatment options. These data also suggest that once methamphetamine became readily available in the area, use significantly increased (50).…”