Racial Disparities in Telehealth Utilization and Health Outcomes Among Older Adults: Evidence from National Health Interview Survey

Background and Purpose: Telehealth has become an essential component of healthcare delivery, particularly emphasized by the COVID-19 pandemic's requirement for remote healthcare solutions. As it reshapes accessibility and management of patient care, particularly for chronic conditions, understanding its equitable implementation across diverse demographics becomes critical. Healthcare access and outcomes are notably disparate across different racial groups, influenced by socioeconomic status, health literacy, and systemic biases. Older adults, due to their increased healthcare needs and potential technological access challenges, represent a pivotal demographic for telehealth analysis. The interplay of age and race in telehealth utilization remains underexplored and holds the potential to unveil significant insights into the benefits and obstacles of telehealth. This study aims to assess how telehealth usage and its impacts on health outcomes vary among older adults across different racial groups.

Methods:

Data and Measurement: Utilizing data from the National Health Interview Survey (NHIS) 2021, this analysis focuses on telehealth usage among adults aged 65 and older. Telehealth services are defined here as making medical appointments online, refilling prescriptions online, or communicating with healthcare professionals via email over the past 12 months. Self-Rated Health (SRH) is employed as an outcome variable, reflecting a comprehensive view of an individual's health status, integrating both physical and psychological dimensions.

Analysis: The study begins with descriptive statistics to delineate the distribution of telehealth usage and SRH across different racial groups, followed by an examination of the correlations between telehealth usage, SRH, and other covariates. A moderation analysis is then conducted to explore how the relationship between telehealth use and SRH varies among racial groups. A stratified analysis for each racial group assesses specific dynamics and potential unique factors impacting each group's SRH concerning telehealth usage.

Results: Older adults who utilized telehealth services reported better SRH compared to non-users, indicating a positive correlation between telehealth usage and perceived health status. However, significant racial disparities were observed as non-Hispanic White participants utilized telehealth more frequently and reported more favorable outcomes than Black, Hispanic, and Asian counterparts. A moderation analysis highlighted that these benefits were particularly pronounced among non-Hispanic Whites. Despite adjusting for socioeconomic factors, health conditions, and technological access, these disparities persisted. The stratified analysis identified specific barriers such as technological literacy, language barriers, and trust issues.

Conclusions and Implications: This study highlights significant racial disparities in telehealth use and associated health outcomes among older adults. Addressing these disparities is critical for optimizing telehealth as a tool for equitable health service delivery. Interventions aimed at reducing socioeconomic and technological barriers, alongside the promotion of multilingual electronic health portals, could mitigate these disparities. Future policies should prioritize enhancing access, technological literacy, and culturally competent care to improve telehealth effectiveness across diverse racial groups.