Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19

Author:

Chunara Rumi12ORCID,Zhao Yuan3,Chen Ji4,Lawrence Katharine45,Testa Paul A5,Nov Oded6,Mann Devin M45

Affiliation:

1. NYU Tandon School of Engineering, Department of Computer Science and Engineering, Brooklyn, New York, USA

2. NYU School of Global Public Health, Department of Biostatistics, New York, New York, USA

3. NYU School of Global Public Health, Department of Epidemiology, New York, New York, USA

4. NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA

5. Medical Center Information Technology, NYU Langone Health, New York, New York, USA

6. Department of Technology Management & Innovation, NYU Tandon School of Engineering, Brooklyn, New York, USA

Abstract

Abstract Objective Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19. Materials and Methods Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results. Results Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58–0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. Discussion There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use. Conclusion Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection—many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.

Funder

National Science Foundation

Publisher

Oxford University Press (OUP)

Subject

Health Informatics

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