Racial and Geographic Disparities in Internet Use in the U.S. Among Patients With Hypertension or Diabetes: Implications for Telehealth in the Era of COVID-19

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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has created challenges for the provision of care for patients with diabetes. Increased physical distancing may worsen the preexisting disease burden and lead to progressively worse outcomes as a result of inadequate outpatient follow-up (1). In such an environment, the telehealth model may offer a valuable solution. However, there may be disparities in access to the internet, especially among individuals suffering from chronic medical conditions and minority patients, which may affect the implementation of the telehealth model. We aimed to assess 1 ) the disparities in internet access among those with hypertension or diabetes versus those without, 2 ) the disparities in internet access among Blacks and Hispanics compared with Whites, and 3 ) the extent of such disparities across the U.S. states. We used data from the 2016 to 2017 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide telephone-based questionnaire administered by the Centers for Disease Control and Prevention among a random sample of U.S. adults regarding health-related behaviors, chronic health conditions, and the use of preventive services, to identify patients ≥18 years who reported having hypertension or diabetes (2). Participants were considered to have used the internet if they answered “Yes” to the question, “Have you used the internet in the past 30 days?” We analyzed these cross-sectional data using survey weights for BRFSS to account for the survey design. We used logistic regression models to study the association between hypertension, diabetes, race, and internet use …

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