Background

Telemedicine addresses barriers to healthcare access and can alleviate health disparities. Recent local and regional studies have found access to telemedicine has not been equitable. We aimed to understand how social vulnerabilities and rurality relate to telemedicine use across the U.S. through large-scale analysis of real-world telemedicine data.

Methods

We conducted a retrospective, observational study of dyadic U.S. telemedicine sessions, occurring between January 1 and December 31, 2022, linked to the 2020 Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We assigned geoidentifiers to patient location for each session and examined the county-level telemedicine use rate (sessions per 1,000 population) in relation to percentile rankings for SVI indices and rurality classifications (rural v. urban) using methods of polynomial regression analysis and data visualization.

Findings

There was a negative, non-linear association between overall social, socio-economic status, household characteristics, and racial and ethnic minority status vulnerabilities and telemedicine use as measured by the SVI, but we found no relationship between telemedicine use and housing type and transportation vulnerability. Telemedicine rates per 1,000 people in urban counties (mean = 16.05, median = 12.26) were approximately double that of urban counties (mean = 8.12, median = 5.04). A comparison of rural vs. urban counties revealed nuanced differences in these associations. Notably, telemedicine use was negatively associated with increased racial and ethnic minority status vulnerability in rural counties but positively associated in urban counties.

Interpretation

U.S. county telemedicine use rates generally decrease as social vulnerability increases. However, rurality has a greater effect on telemedicine use than social vulnerability, and the nature of the relationship between social vulnerability and telemedicine use differs for rural vs. urban areas.

Citation

Cummins, Mollie R. and Wong, Bob and Wan, Neng and Han, Jiuying and Shishupal, Sukrut D. and Gouripeddi, Ramkiran and Ivanova, Julia and Franklin, Asiyah and Ong, Triton and Johnny, Jace and Welch, Brandon M. and Bunnell, Brian E. Social Vulnerability and Rurality Associated with Lower Telemedicine Use in U.S. Counties
URL: https://ssrn.com/abstract=4726267