Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic

Abstract

Introduction: The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. Methods: The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. Results: The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Conclusions: Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.

Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study

“…One key study finding is that patients with breast cancer living in greater socioeconomically disadvantaged neighborhoods were less likely to use telemedicine for care and services, consistent with previous studies of patients in primary care, adult outpatient, and hematology or oncology settings [ 8 , 24 - 28 ]. A descriptive study suggested no correlation between ADI scores and interest in telehealth visits among 64 patients with head and neck cancers (interested: median ADI score=4.0 vs not interested: median ADI score=5.0; P =.79) [ 27 ], but the small sample size limited the reliability of these findings.…”

“…Neighborhood socioeconomic disadvantage has been shown to negatively affect health outcomes [ 17 , 18 ], access to care and preventive services [ 19 , 20 ], survival outcomes [ 18 , 21 ], and quality of life [ 22 ] among patients with cancer [ 23 ]. Previous investigations have also found neighborhood socioeconomic disadvantage to be associated with a lower likelihood of telemedicine use among patients in primary care and hematology or oncology clinics, as well as among outpatients [ 8 , 24 - 28 ]. A study of 627 patients with cancer experiencing financial distress during the COVID-19 pandemic reported a 3% decrease in the rate of telemedicine use per 10-unit increase in the Area Deprivation Index (ADI) [ 8 ], a validated composite measure of neighborhood-level SES [ 29 , 30 ].…”

Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid

“…The ADI was selected because it is the only composite measure available at the census block group level, 21 was designed for use in analyzing mortality 22 and health care outcomes, 19 and has been associated with inequities in telemedicine utilization. 23 An important caveat of composite, census-based measures, such as the ADI, is that prior research evaluating California's “Healthy Places Index” composite measure (which has many similarities with ADI) indicated that this index underrepresented NHPI populations, 24 but there has not, to our knowledge, been a specific measure of neighborhood disadvantage developed and validated for NHPI populations. The Social Vulnerability Index, which includes a measure of race and ethnicity, was not selected because it was designed for disaster management and for larger geographic levels.…”

Advancing regulatory science through real-world data and real-world evidence

“…Opportunities for DHTs to generate RWD/RWE [15,[21][22][23] Digital health technologies (DHTs) offer a host of opportunities to change how healthcare is delivered, tracked, and disseminated. DHTs are defined by FDA as integrated systems that use computing platforms, connectivity, software, and/or sensors for healthcare.…”