Race, geography defined telemedicine use early in pandemic, data reveal

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A new cross-sectional study of Medicare-enrollees shows that Black and Hispanic Americans, after controlling for geography and demographic factors, were less likely to receive telemedicine care than White individuals during the first full year of the pandemic.

The study, published in JAMA Health Forum, showed that while racial minorities disproportionately live in geographic regions with higher telemedicine use, they used the services less than their White peers.

The study was based on data from 14,305,819 people continuously enrolled in traditional Medicare from March 2020 to February 2022. Of those, 7.4% reported that they were Black, 5.6% Hispanic, and 4.2% other race.

Prior to the pandemic, telemedicine was feared to be part of the "digital divide," which saw racial minorities using newer technology at lower rates than White patients.

"This concern is particularly relevant to mental health treatment, given that the pandemic-associated increase in mental health symptoms and telemedicine use during the pandemic has been highest for mental health conditions," the authors wrote.

Uncontrolled, controlled analyses differ

Previous studies have shown disparate findings about telemedicine use in the pandemic, with some showing higher use among Blacks and Hispanics and others showing higher use among Whites.

The authors hypothesized that these discrepancies are due to geography: Black and Hispanic populations may be more likely to receive telemedicine because they are more likely to live in urban communities served by large healthcare systems that use telemedicine.

The primary study outcome was the number of telemedicine visits per patient during the second pandemic year. Among all enrollees, there were 93.3 telemedicine visits per 100 Medicare enrollees during the second pandemic year.

In uncontrolled analysis, Black and Hispanic enrollees had 17.9% and 35.3%, more telemedicine visits compared to White enrollees, respectively. But after controlling for age, sex, and geography, all racial and ethnic minority groups had substantially fewer telemedicine visits per 100 patients, the authors said.

Differences in visits rates translated into relative differences of −8.5% (95% confidence interval [CI], −9.1% to −7.8%), −14.1% (95% CI, −14.9% to −13.5%), and −9.9% (95% CI, −10.7% to −9.1%) respectively for Black patients, Hispanic patients, and those of other racial groups compared with White enrollees, the authors found.

There was significant geographic variation in telemedicine visit rates during the second year of the pandemic.

"There was significant geographic variation in telemedicine visit rates during the second year of the pandemic, with greater uptake in the Southwest and Northeast across all individuals," they wrote. "If telemedicine is to achieve its potential to expand access to care and reduce existing disparities, federal, local, and health system policies are needed to improve digital health equity."

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