Models adjusting for geography show racial gaps in telehealth use

March 27, 2024 - Racial minority groups received more telehealth visits per capita during the COVID-19 pandemic; however, after controlling for geographic region and other factors, a new study shows that these groups received fewer telehealth visits than their White peers.

Published in JAMA Health Forum, the study aims to provide clarity regarding the opposing research findings on telehealth use by racial and ethnic minority groups compared with White individuals.

While some studies show that Black and Hispanic individuals are more likely to use telehealth than White individuals, others show the opposite. For example, one study published in 2022 revealed that Black and Hispanic people were 35 percent and 51 percent less likely to use telehealth, respectively, compared to White people. On the other hand, there is evidence showing that low-income Hispanic patients are more likely to use telehealth than their White peers and that telehealth spurred an increase in post-discharge follow-up appointments among Black patients compared to White.  

Thus, the new study aimed to quantify racial and ethnic differences in telehealth use with and without accounting for demographic and clinical characteristics and geography.

Researchers from Massachusetts and Virginia conducted a cross-sectional study that included data from 14.3 million United States adults continuously enrolled in traditional Medicare from March 2020 to February 2022 or until death. They categorized the patient population according to race and ethnicity: Black, Hispanic, White, and other (American Indian/Pacific Islander, Alaska Native, and Asian).

The research team analyzed total telehealth visits, including audiovisual and audio-only visits, and total visits per individual, both telehealth and in-person, during the study period.

Of the 14.3 million patients included in the study, 7.4 percent reported being Black, 5.6 percent Hispanic, and 4.2 percent other race. There were 93.3 telehealth visits per 100 individuals during the second pandemic year, from March 2021 to February 2022. During this time, there was higher telehealth uptake among Black and Hispanic individuals in geographic areas with higher proportions of racial and ethnic minority groups.

Using a model that included only race and ethnicity, researchers found that Black individuals had 16.7, Hispanic individuals 32.9, and individuals of other racial groups 20.9 more telehealth visits per 100 individuals compared with White individuals.

Compared with the rate of telehealth visits in the total population, Black individuals had 17.9 percent, Hispanic individuals 35.3 percent, and other racial groups 22.4 percent more telehealth visits.

However, after also controlling for geography, researchers observed that all racial and ethnic minority groups had substantially fewer telehealth visits per 100 patients compared with White individuals.

The differences in visit rates translated to 8.5 percent fewer virtual visits for Black individuals, 14.1 percent fewer virtual visits for Hispanic individuals, and 9.9 percent fewer virtual visits for other racial groups versus White individuals.

Further, the study shows that Black, Hispanic, and individuals of other racial groups had more audio-only visits than their White counterparts in unadjusted models. However, in fully adjusted models controlling for demographic and clinical factors and geography, telehealth use patterns changed: Hispanic patients had 0.8 fewer audio-only visits per 100 individuals, while Black individuals had 1.6 more audio-only visits per 100 individuals compared with White individuals.

In contrast, unadjusted and fully adjusted models for telemental healthcare showed that minority groups received fewer virtual visits than White patients.

Fully adjusted models revealed that compared with the total population, Black individuals had 19.1 percent fewer, Hispanic patients 19.7 percent fewer, and patients of other racial groups 18.6 percent fewer telehealth visits for mental healthcare.

“In the context of this analysis, we focus on the results that were conditional on geography and believe that they highlight factors concerning differential use of telemedicine by race and ethnicity,” the researchers wrote. “These differences could be associated with the same factors that underlie why there is differential use of in-person visits.”

They added that federal, local, and health system policies must focus on improving digital health equity for telehealth to expand healthcare access and reduce racial disparities successfully.