Division of General Internal Medicine, Massachusetts General Hospital, Boston.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA Health Forum. 2024 Mar 1;5(3):e240131. doi: 10.1001/jamahealthforum.2024.0131.
Individuals of racial and ethnic minority groups may be less likely to use telemedicine in part due to lack of access to technology (ie, digital divide). To date, some studies have found less telemedicine use by individuals of racial and ethnic minority groups compared with White individuals, and others have found the opposite. What explains these different findings is unclear.
To quantify racial and ethnic differences in the receipt of telemedicine and total visits with and without accounting for demographic and clinical characteristics and geography.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included individuals who were continuously enrolled in traditional Medicare from March 2020 to February 2022 or until death.
Race and ethnicity, which was categorized as Black non-Hispanic, Hispanic, White non-Hispanic, other (defined as American Indian/Pacific Islander, Alaska Native, and Asian), and unknown/missing.
Total telemedicine visits (audio-video or audio); total visits (telemedicine or in-person) per individual during the study period. Multivariable models were used that sequentially adjusted for demographic and clinical characteristics and geographic area to examine their association with differences in telemedicine and total visit utilization by documented race and ethnicity.
In this national sample of 14 305 819 individuals, 7.4% reported that they were Black, 5.6% Hispanic, and 4.2% other race. In unadjusted results, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 16.7 (95% CI, 16.1-17.3), 32.9 (95% CI, 32.3-33.6), and 20.9 (95% CI, 20.2-21.7) more telemedicine visits per 100 beneficiaries, respectively. After adjustment for clinical and demographic characteristics and geography, compared with White individuals, Black individuals, Hispanic individuals, and individuals of other racial groups had 7.9 (95% CI, -8.5 to -7.3), 13.2 (95% CI, -13.9 to -12.6), and 9.2 (95% CI, -10.0 to -8.5) fewer telemedicine visits per 100 beneficiaries, respectively. In unadjusted and fully adjusted models, and in 2019 and the second year of the COVID-19 pandemic, Black individuals, Hispanic individuals, and individuals of other racial groups continued to have fewer total visits than White individuals.
The results of this cross-sectional study of US Medicare enrollees suggest that although nationally, Black individuals, Hispanic individuals, and individuals of other racial groups received more telemedicine visits during the pandemic and disproportionately lived in geographic regions with higher telemedicine use, after controlling for geographic region, Black individuals, Hispanic individuals, and individuals of other racial groups received fewer telemedicine visits than White individuals.
由于缺乏技术（即数字鸿沟），少数族裔群体的个人可能不太可能使用远程医疗。迄今为止，一些研究发现，与白人相比，少数族裔群体使用远程医疗的情况较少，而其他一些研究则发现相反的情况。这些不同的发现背后的原因尚不清楚。
定量研究种族和民族差异在接受远程医疗以及在不考虑人口统计学和临床特征以及地理位置的情况下计算的总就诊次数中的差异。
设计、设置和参与者：这项横断面研究纳入了 2020 年 3 月至 2022 年 2 月期间或直至死亡前连续参加传统医疗保险的个人。
种族和民族，分为黑人非西班牙裔、西班牙裔、白种非西班牙裔、其他（定义为美洲印第安人/太平洋岛民、阿拉斯加原住民和亚洲人）和未知/缺失。
总远程医疗就诊次数（音频-视频或音频）；研究期间每位个体的总就诊次数（远程医疗或面对面）。使用多变量模型，依次调整人口统计学和临床特征以及地理区域，以检查它们与记录的种族和民族差异在远程医疗和总就诊利用方面的关联。
在这项针对 14305819 名个体的全国性样本中，7.4%的人报告自己是黑人，5.6%的人是西班牙裔，4.2%的人是其他种族。在未调整的结果中，与白人相比，黑人、西班牙裔和其他种族的个体的远程医疗就诊次数分别多 16.7（95%置信区间，16.1-17.3）、32.9（95%置信区间，32.3-33.6）和 20.9（95%置信区间，20.2-21.7）次/每 100 名参保人。在调整临床和人口统计学特征以及地理位置后，与白人相比，黑人、西班牙裔和其他种族的个体的远程医疗就诊次数分别减少了 7.9（95%置信区间，-8.5 至-7.3）、13.2（95%置信区间，-13.9 至-12.6）和 9.2（95%置信区间，-10.0 至-8.5）次/每 100 名参保人。在未调整和完全调整的模型中，以及在 2019 年和 COVID-19 大流行的第二年，黑人、西班牙裔和其他种族的个体的总就诊次数仍少于白人。
这项针对美国医疗保险参保者的横断面研究结果表明，尽管在全国范围内，黑人和西班牙裔以及其他种族的个体在大流行期间接受了更多的远程医疗服务，并且不成比例地居住在远程医疗使用率较高的地理位置，但在控制地理位置后，黑人和西班牙裔以及其他种族的个体接受的远程医疗服务比白人少。
