Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA.
Department of Health Policy and Management, University of California, Los Angeles, California, USA.
J Rural Health. 2022 Jun;38(3):512-518. doi: 10.1111/jrh.12614. Epub 2021 Aug 6.
To examine characteristics associated with disparities in digital access (i.e., access to high-speed Internet via a computer or smartphone) in American rural and urban households given that digital access has a direct impact on access to telemedicine-based services.
Using the 2019 American Community Survey, we analyzed the proportions of geographic area, race/ethnicity, and socioeconomic status according to device and high-speed Internet access. Maximum likelihood logit estimators estimated how these factors influenced device and high-speed Internet access.
Of 105,312,959 households, 32.29% were without a desktop or laptop computer with high-speed Internet (WDW), 21.51% were without a smartphone with a data plan for wireless Internet (WSW), and 14.02% were without any digital access (WDA). Nonmetropolitan households were significantly more likely to be WDA than metropolitan households (odds ratio [OR] = 1.87; 95% confidence interval [CI]: 1.83-1.91). Relative to non-Hispanic Whites, non-Hispanic Blacks (OR = 1.60; 95% CI: 1.56-1.64), American Indian or Alaska natives (OR = 2.00; 95% CI: 1.82-2.19), or Hispanics (OR = 1.70; 95% CI: 1.66-1.74) were significantly more likely to be WDA. When compared to households with private health insurance coverage, households WDA were significantly more likely to have no insurance (OR = 2.44; 95% CI: 2.36-2.53) or public insurance coverage (OR = 3.78; 95% CI: 3.70-3.86). Households with any digital access reported higher income and more family members living at home. Using the same predictors, similar findings were reported for households WDW or WSW.
Significant disparities in digital access exist among nonmetropolitan households, racial/ethnic minority households, and lower-income households. The lack of digital access has implications for the accessibility of health care services via telemedicine and thus could exacerbate health disparities.
鉴于数字接入直接影响远程医疗服务的获取，本研究旨在探讨美国农村和城市家庭中与数字接入差距相关的特征。
本研究使用 2019 年美国社区调查数据，根据设备和高速互联网接入情况，分析了地理区域、种族/民族和社会经济地位的比例。最大似然对数几率估计值用于估计这些因素如何影响设备和高速互联网接入。
在 105312959 户家庭中，有 32.29%没有带高速互联网的台式或笔记本电脑（WDW），21.51%没有带数据计划的智能手机用于无线上网（WSW），14.02%没有任何数字接入（WDA）。与城市家庭相比，非大都市家庭更有可能没有数字接入（优势比[OR] = 1.87；95%置信区间[CI]：1.83-1.91）。与非西班牙裔白人相比，非西班牙裔黑人（OR = 1.60；95%CI：1.56-1.64）、美国印第安人或阿拉斯加原住民（OR = 2.00；95%CI：1.82-2.19）或西班牙裔（OR = 1.70；95%CI：1.66-1.74）更有可能没有数字接入。与有私人医疗保险的家庭相比，没有数字接入的家庭更有可能没有保险（OR = 2.44；95%CI：2.36-2.53）或公共医疗保险（OR = 3.78；95%CI：3.70-3.86）。任何数字接入的家庭报告收入更高，家中居住的家庭成员也更多。使用相同的预测因素，对于 WDW 或 WSW 的家庭也有类似的发现。
非大都市家庭、少数族裔家庭和低收入家庭在数字接入方面存在显著差距。缺乏数字接入会影响远程医疗服务的可及性，从而可能加剧健康差距。
