The flip side of e-health: A population wide cross-sectional study into the differences in e-health access, use, and perceived benefit between different socio-economic groups (Preprint)

Abstract

Background: There is a growing concern that digital healthcare may exacerbate existing differences in health. Digital healthcare or e-health is defined as the digital applications that are used in healthcare. Differences in access to and perceived benefits of digital technology among socio-economic groups are commonly referred to as the digital divide. While research on differences in health outcomes between socio-economic groups in the context of e-health has focused mainly on single interventions, there is a need for greater understanding of population-wide disparities in e-health access, use, and perceived benefits.

Objective: The aim of this study is to investigate e-health access, usage, and perceived benefits across different socio-economic groups within the Dutch population.

Methods: A survey was conducted among 1,500 panel members of the Nivel Dutch Health Care Consumer Panel to assess their access to, use of, and perceived benefits of e-health. Results were stratified into nine socio-economic position (SEP) populations based on three indicators: education, standardized income, and socio-economic status level of the neighborhood. Logistic regression analyses were carried out to evaluate whether the outcomes varied significantly across different SEP groups. To control for confounding, age was included as a covariate.

Results: The response rate was 56.6% (849/1500). Subpopulations with low SEP have less access to and use of e-health than subpopulations with medium or high SEP. The difference in access (OR 5.72, 95% CI 3.06 - 10.72) and usage (OR 4.96, 95% CI 2.66 - 9.24) of e-health between low and highly educated respondents is most profound.

Conclusion: This study found that access and usage of e-health varied significantly among low, medium, and high SEP groups in the Dutch population, depending on the SEP indicators used. The results underline the importance of activities and policies aimed at improving e-health accessibility and usage among low SEP groups to reduce disparities in health between difference socio-economic groups.