Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study

Abstract

Background The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic.

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“… 3 Because Japanese residents tend to be more risk-averse than those in other countries, 27 the risk preference for COVID-19 infection may have influenced health care utilization, especially among the elderly who are at higher risk of experiencing severe infection. In Japan, because the application and spread of telemedicine have been slow even during the pandemic, 28 access to care, especially for new health-related events, is impaired in the population. Thus, it is necessary to improve access to health care by telemedicine expansion while considering the quality and safety of care and usability.…”

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“…Although disparities in access to telemedicine by age and socioeconomic status have been well-documented, evidence is limited as to how these disparities were changed during the pandemic. In Japan, for example, younger individuals increased their use of telemedicine compared to older individuals, although individuals in their 70s also increased their use of telemedicine [ 81 ].…”

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“…According to a survey by the MHLW in January 2021, the number of medical institutions which introduced telemedicine after the authorization of the government increased from 10,812 (9.7% of all institutions in Japan) in April 2020 to 16,095 (14.5%) in June [74] . However, this number nearly plateaued for the rest of the year.…”

“…Telemedicine was also popular among Japanese patients. In a large Internet survey conducted in two different periods during the COVID-19 pandemic in Japan, of 24,526 participants aged 18-79 years (50.8% women), 2.0% ( n = 497) reported using telemedicine in April 2020 and 4.7% ( n = 1159) during August-September 2020 [ 75 ] . During the pandemic the use of telemedicine was increased more in younger than older individuals, except for subjects in their 70s who showed higher frequencies of telemedicine use.…”