Cancer Patients with Low Socioeconomic Status Used Telehealth Less

Newly diagnosed cancer patients with high socioeconomic status were more likely to have a telehealth visit in the 30 days following their diagnosis compared to patients with low socioeconomic status, according to a study published in JAMA Oncology.

Telehealth has increased access to care for many individuals, especially during the COVID-19 pandemic. But social determinants of health and care disparities can exacerbate the digital divide and make telehealth unattainable for some populations.

Using claims data from the HealthCore Integrated Research Database, researchers from the University of Kansas analyzed 16,006 patients who were newly diagnosed with breast, lung, prostate, or colorectal cancer between January 1 and August 31, 2020.

Around half of the patients were between 18 and 64 years old while the other half were over 65.

Unsurprisingly, telehealth visit volumes rose from 0.4 percent in January to its height of 54 percent in April 2020. But telehealth use among the study population was divided based on socioeconomic status.

When visits peaked in April, nearly 70 percent of patients in the top socioeconomic quartile had a telehealth appointment within 30 days of their cancer diagnosis. In contrast, only 47 to 48 percent of patients in the lower socioeconomic quartiles had a telehealth visit during this time.

The rate of telehealth visits declined slightly in the months following April 2020, but the patients with the highest socioeconomic status maintained the highest rate of telehealth use in each month compared to their lower socioeconomic status counterparts.

Additionally, researchers found that patients in the highest socioeconomic quartile were 31 percent more likely to have a telehealth visit following their cancer diagnosis than patients in the lowest quartile.

The study results suggest that telehealth capabilities may be widening health disparities for some populations rather than increasing access to care.

Telehealth video visits require access to technology, including a device with camera capabilities and stable internet connection, both of which are not always readily available to low-income or rural populations.

While healthcare leaders have initiated programs and partnerships that aim to increase access to virtual healthcare services for underserved communities, social determinants of health barriers still stand in the way of accessing telehealth.

A separate study found that sociodemographic factors such as race and age may also impact access to telehealth appointments, with racial minority status and older age contributing to the lower likelihood of a successful video visit.

Limited English proficiency and low digital literacy are also factors that can act as barriers to telehealth use.

Until telehealth delivery prioritizes equitable access for all, the digital divide for patients with low socioeconomic status, as well as rural and minority populations, is likely to remain. Additionally, increased audio-only telehealth coverage may help facilitate access for patients with limited technology and broadband availability.