Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19

Abstract

Objective Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage and treatment. Racial and ethnic disparities in health care have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19 . Materials and Methods Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis and COVID test results. Results Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95%CI:0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. Discussion There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of Zip code were also significantly related to telemedicine use. Conclusion Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection; many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.

Where to make a difference: research and the social determinants in pediatrics and child health in the COVID-19 era

“…Access to patient portals, telemedicine, and digital health is dependent on social class and poverty levels, both urban and rural., with marked disparities in cities. [28][29][30][31]…”

The Internet as a Route to Health Information, Support, and Healthcare for Cancer Survivors

“…32 At the same time, the study found an increase in the proportion of Black patients accessing urgent virtual care from 2019 to 2020, driven by a younger, female population. 32 In summary, given the increasing number of cancer survivors, the growth in health-related internet use among this population, and the likelihood that both trends will continue, the internet should continue to be leveraged to provide cancer survivors with personally tailored information and support services to manage the late and long-term effects of cancer and its treatment. At the same time, persistent disparities in access to the internet must be considered, and systematic approaches to lowering barriers-such as universal broadband internet access and efforts to increase health literacy, among others-must be prioritized for digital health to achieve its potential of improved access to health for all.…”

“…Although this new method of healthcare delivery may be a welcome alternative for many cancer survivors-similar to the findings by Dee et al-a large cohort study on the use of virtual care during the COVID-19 pandemic suggests that virtual care may exacerbate healthcare disparities for others. 32 Specifically, those who were Black, with a home zip code with a lower mean income, and with higher average household size were less likely to use telemedicine to seek care. 32 At the same time, the study found an increase in the proportion of Black patients accessing urgent virtual care from 2019 to 2020, driven by a younger, female population.…”

“…32 Specifically, those who were Black, with a home zip code with a lower mean income, and with higher average household size were less likely to use telemedicine to seek care. 32 At the same time, the study found an increase in the proportion of Black patients accessing urgent virtual care from 2019 to 2020, driven by a younger, female population. 32 In summary, given the increasing number of cancer survivors, the growth in health-related internet use among this population, and the likelihood that both trends will continue, the internet should continue to be leveraged to provide cancer survivors with personally tailored information and support services to manage the late and long-term effects of cancer and its treatment.…”

Elective Care and Health Services Research in the COVID-19 Era

“…We desperately need more research, such as that from Whaley and colleagues, 3 Nonetheless, as their study demonstrates, the rapid shift in the care we provide and how we provide it has created new disparities, confirming reports from other investigators. 4 This likely reflects the well-characterized digital divide that exists among racial/ethnic minority, low-income, and rural populations. Moreover, the health care organizations on which they rely have experienced greater losses of revenue and taxes that support the care they provide, leaving them with even fewer resources to support virtual care.…”