COVID-19 Narrowed Down Black-White Older Adults’ Digital Divide in Telehealth: Subgroup Analysis of Gender, Education, and Income

Background: The onset of the pandemic in 2020 has catalyzed a shift to virtual platforms for various aspects of daily life, especially for healthcare services. Emerging research suggests the reduced gaps between non-Hispanic Black and White older adults in telehealth usage due to the COVID-19 pandemic. The intersectionality framework indicates the multifaced nature of the digital divide related to race/ethnicity, gender, and socioeconomic status (SES). However, no studies have examined the impact of COVID-19 on telehealth disparities from an intersectionality lens. Thus, in this study, we aimed to examine 1) how COVID-19 impacted the racial/ethnic disparities in telehealth usage among older adults in the US and 2) how COVID-19 impacted the racial/ethnic disparities among older adults of different gender and SES subgroups.

Methods: 2015-2021 NHATS data were used in this study. Pre-COVID period was defined as 2015-2019, and amidst-COVID period was defined as 2020 and 2021. Mixed-effect logistic regression models were conducted to examine the effects of interaction between COVID-19 period and race/ethnicity on telehealth use, including contacting medical health provider, handling health insurance, and looking up health information. Subgroup analyses were also performed based on gender, education, and income.

Results: The interactions between COVID-19 period and Black were found significant in contacting medical providers (OR = 1.45, 95% CI= 1.04-2.02), handling health insurance (OR = 1.77, 95% CI= 1.02-2.50), and looking for health information (OR = 1.59, 95% CI= 1.15-2.20). These findings indicate the reduced racial/ethnic gaps in telehealth usage between non-Hispanic Black and White older adults after COVID-19. By-gender analyses showed that interactions between COVID-19 period and Black in contacting medical providers (OR = 1.78, 95% CI= 1.16-2.73) and handling health insurance (OR = 2.23, 95% CI= 1.41-3.54) were only significant among older women, whereas the interaction was only significant among older men when predicting searching health information online (OR = 1.80, 95% CI= 1.07-3.04). By-education analyses showed that the interactions were only significant in the high-education group (health provider: OR = 1.71, 95% CI= 1.16-2.53; health insurance: OR = 1.76, 95% CI= 1.17-2.64; and health information: OR = 1.55, 95% CI= 1.06-2.26). By-income analyses showed that the interactions in predicting contacting medical providers (OR = 2.51, 95% CI= 1.28-4.93), handling health insurance (OR = 2.23, 95% CI= 1.12-4.44), and searching for health information (OR = 2.08, 95% CI= 1.11-3.88) were significant in the low-income group. In the medium-to-high income group, only the interaction for handling health insurance was significant (OR = 1.74, 95% CI= 1.06-2.86).

Discussion: Findings in this study showed that COVID-19 pandemic narrowed down Black-White gaps in telehealth among older adults, especially those who are women and with low income. However, this narrow-down also happened in the high education group but not low-education group, indicating low education is still a strong barrier to telehealth use for many non-Hispanic Black older adults. Future technology training should be focused more on low educated older adults and develop training protocols that fit their level of literacy.