Standaar Lucille, van Tuyl Lilian, Suijkerbuijk Anita, Brabers Anne, Friele Roland
Department of Population Health and Health Services Research, Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Department Organisation and Quality of Care, Netherlands Institute for Health Services Research, Utrecht, Netherlands.
JMIR Form Res. 2025 Jan 7;9:e49585. doi: 10.2196/49585.
There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently.
This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables-education, standardized income, and the socioeconomic status of the neighborhood.
A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators-education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding.
This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education.
The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups.
人们越来越担心数字医疗保健可能会加剧现有的健康差距。数字医疗保健或电子健康涵盖了在医疗保健中使用的数字应用程序。社会经济群体在数字技术的获取、使用和感知收益方面的差异通常被称为数字鸿沟。当前研究表明，社会经济地位较低的人群使用电子健康的频率较低。
本研究旨在（1）调查荷兰成年人群中社会经济地位与电子健康的获取、使用和感知收益之间的关联，以及（2）通过教育、标准化收入和邻里社会经济地位这三个社会经济变量评估电子健康在获取、使用和感知收益方面的差异。
对荷兰Nivel医疗保健消费者小组的数据（回复率57%，849/1500）进行二次分析，以评估电子健康的获取、使用和感知收益。收集这些数据是为了监测荷兰的电子健康发展情况。通过两个概念对电子健康进行了考察：（1）一般意义上的电子健康，以及（2）网站、应用程序和可穿戴设备。结果根据教育、标准化收入和邻里社会经济地位水平这三个指标被分层为9个社会经济地位群体。进行逻辑回归分析以评估不同社会经济地位群体的结果是否存在显著差异。纳入年龄作为协变量以控制混杂因素。
本研究证实了电子健康与社会经济地位之间的关联，并表明与社会经济地位中等或较高的受访者相比，社会经济地位较低的受访者获取电子健康的机会较少（优势比[OR]5.72，95%置信区间3.06 - 10.72）且使用频率较低（OR 4.96，95%置信区间2.66 - 9.24）。在按教育水平分层时差异最为显著。
电子健康的获取和使用存在社会经济梯度，并强调不能互换使用社会经济地位指标来评估电子健康的获取和使用情况。结果强调了旨在提高社会经济地位较低群体的电子健康可及性和使用率以减轻不同社会经济群体之间健康差距的活动和政策的重要性。
