Health Inequalities in the Use of Telehealth in the United States in the Lens of COVID-19.

ABSTRACT

The use of remote health care services, or telehealth, is a promising solution for providing health care to those unable to access care in person easily and thus helping to reduce health inequalities. The COVID-19 pandemic and resulting stay-at-home orders in the United States have created an optimal situation for the use of telehealth services for non-life-threatening health care use. A retrospective cohort study was performed using Kantar's Claritis™ database, which links insurance claims encounters (Komodo Health) with patient-reported data (Kantar Health, National Health & Wellness Survey). Logistic regression models (odds ratios [OR], 95% confidence intervals [CI]) examined predictors of telehealth versus in-person encounters. Adults ages ≥18 years eligible for payer-complete health care encounters in both March 2019 and March 2020 were identified (n = 35,376). Telehealth use increased from 0.2% in 2019 to 1.9% in 2020. In adjusted models of respondents with ≥1 health care encounter (n = 11,614), age, marital status, geographic residence (region; urban/rural), and presence of anxiety or depression were significant predictors of telehealth compared with in-person use in March 2020. For example, adults 45-46 years versus 18-44 years were less likely to use telehealth (OR 0.684, 95% CI 0.561-0.834), and respondents living in urban versus rural areas were more likely to use telehealth (OR 1.543, 95% CI 1.153-2.067). Substantial increases in telehealth use were observed during the onset of the COVID-19 pandemic in the United States; however, disparities existed. These inequalities represent the baseline landscape that population health management must monitor and address during this pandemic.