Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS)

Abstract

The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods: Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results: Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion: Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.

The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation

“…The significant reduction in geographic barriers and the subsequent increase in healthcare access is a key outcome of this study, aligning with the overarching goal of telemedicine to overcome spatial limitations in healthcare delivery [22]. The findings emphasize the potential of telemedicine to address healthcare disparities by improving access for people living in remote or underserved areas [23]. The decrease in the frequency of healthcare utilization suggests that telemedicine not only improves accessibility but also streamlines healthcare delivery, minimizing unnecessary visits and optimizing resource allocation [2].…”

Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS) [Letter]

“…The results of this research have advantages, namely: 1) Focus on comparative analysis of telemedicine usage patterns among adult populations living in rural and urban areas during the COVID-19 pandemic, 2) Evaluation of the probability of telemedicine adoption among adults living in rural and urban areas, 3) Emphasis on sociodemographic factors that influence access to healthcare, 4) Highlighting disparities in telemedicine use, particularly in rural areas, 5) Emphasizing the importance of healthcare strategies tailored to the unique characteristics of rural areas to achieve equitable access to healthcare. 1 …”

“…The results of this research have advantages, namely: 1) Focus on comparative analysis of telemedicine usage patterns among adult populations living in rural and urban areas during the COVID-19 pandemic, 2) Evaluation of the probability of telemedicine adoption among adults living in rural and urban areas, 3) Emphasis on sociodemographic factors that influence access to healthcare, 4) Highlighting disparities in telemedicine use, particularly in rural areas, 5) Emphasizing the importance of healthcare strategies tailored to the unique characteristics of rural areas to achieve equitable access to healthcare. 1 However, we have also discovered several limitations that need to be corrected in the future, namely: 1) Use of crosssectional data from the 2021 NHIS to investigate the relationship between telemedicine use and rural disparities. This may limit the ability to evaluate changes in telemedicine use over time, 2) The questionnaire for telemedicine use did not investigate the types and proportions associated with the modality, so the associations found may vary depending on the modality type, 3) Telemedicine use data was obtained through self-reported responses in the questionnaire, which may lead to the potential for underestimation due to responses that may be too low or too high, 4) Limitations in estimating the extent of telemedicine use in 2021, which may reflect the changing healthcare environment during the study period.To obtain better results, we recommend that further research be carried out by 1) Using data that tracks telemedicine use over time will provide a better understanding of changes in telemedicine use patterns over time, 2) Investigating the types of telemedicine used and the proportion of use could provide greater insight into telemedicine usage preferences, 3) Validating telemedicine usage data with other sources, such as electronic medical records, 2 could help ensure the accuracy of results, 4) Conducting qualitative research to understand individuals' perceptions and experiences related to telemedicine usage, as well as the barriers they face, could provide greater insight, 5) Investigating the impact of telemedicine-related policies, such as long-term payment policies, could provide an understanding of how such policies affect telemedicine access and usage.…”

“…The results of this research have advantages, namely: 1) Focus on comparative analysis of telemedicine usage patterns among adult populations living in rural and urban areas during the COVID-19 pandemic, 2) Evaluation of the probability of telemedicine adoption among adults living in rural and urban areas, 3) Emphasis on sociodemographic factors that influence access to healthcare, 4) Highlighting disparities in telemedicine use, particularly in rural areas, 5) Emphasizing the importance of healthcare strategies tailored to the unique characteristics of rural areas to achieve equitable access to healthcare. 1 However, we have also discovered several limitations that need to be corrected in the future, namely: 1) Use of crosssectional data from the 2021 NHIS to investigate the relationship between telemedicine use and rural disparities. This may limit the ability to evaluate changes in telemedicine use over time, 2) The questionnaire for telemedicine use did not investigate the types and proportions associated with the modality, so the associations found may vary depending on the modality type, 3) Telemedicine use data was obtained through self-reported responses in the questionnaire, which may lead to the potential for underestimation due to responses that may be too low or too high, 4) Limitations in estimating the extent of telemedicine use in 2021, which may reflect the changing healthcare environment during the study period.…”