Cortese Brian D, Alkhatib Khalid Y, Harmatz I Mitchell, Michel Katharine F, Lee Daniel J, Guzzo Thomas J, Vaughn David J, Moses Kelvin A, Pierorazio Phillip M, Talwar Ruchika
Department of Urology, Vanderbilt University Medical Center Nashville, TN, USA.
Division of Urology, Department of Surgery, University of Pennsylvania Health System Philadelphia, PA, USA.
Am J Cancer Res. 2025 Mar 15;15(3):1224-1233. doi: 10.62347/RNJS4301. eCollection 2025.
Codification of COVID-19-era use of telemedicine as a permanent feature of US healthcare has been discussed as it may increase accessibility and equity. This study assesses whether telemedicine is associated with improved differential access to cancer care for racial and ethnic minorities. We conducted a cross-sectional analysis of the National Health Interview Survey from July 2020 to December 2021 and estimated prevalence of telemedicine utilization in both the study population (N=46,799) and in a subgroup of cancer patients (N=7,784). Complex survey-weighted multivariable Poisson regression identified patient-level predictors and estimated risk ratios (RR) for telemedicine receipt. Two-way interaction between cancer type and race and ethnicity assessed effect modification. Telemedicine prevalence was 35.5% [95% CI: 34.8%-36.2%] for the overall study population and 48.7% [95% CI: 47.0%-50.4%] for cancer patients. Weighted multivariable Poisson regression revealed that non-Hispanic Black (NHB) and non-Hispanic Asian (NHA) individuals had lower receipt compared to non-Hispanic White (NHB RR: 0.87, 95% CI: [0.83-0.92], P<0.01; NHA RR: 0.8, 95% CI: [0.74-0.86], P<0.01). This racial and ethnic disparity disappeared among cancer patients. Adjusted risk difference (ARD) analysis indicated no difference in decreased telemedicine utilization by cancer type except for breast cancer (NHB ARD: -0.16, 95% CI: [-0.27-(-0.05)], P=0.01) and lymphoma (Other ARD: -0.36, 95% CI: [-0.72-(-0.01)], P=0.05). Racial and ethnic disparities in telemedicine utilization decreased for cancer patients compared to the overall population. While racial and ethnic disparities persisted in two oncologic subgroups, telemedicine overall improved access and may increase equity in oncologic care.
将新冠疫情期间远程医疗的使用编纂为美国医疗保健的一项永久性特征已被讨论，因为这可能会增加可及性和公平性。本研究评估远程医疗是否与改善种族和族裔少数群体获得癌症护理的差异相关。我们对2020年7月至2021年12月的《国家健康访谈调查》进行了横断面分析，并估计了研究人群（N = 46,799）和癌症患者亚组（N = 7,784）中远程医疗的使用率。复杂的调查加权多变量泊松回归确定了患者层面的预测因素，并估计了接受远程医疗的风险比（RR）。癌症类型与种族和族裔之间的双向交互作用评估了效应修正。整个研究人群的远程医疗使用率为35.5% [95% CI：34.8%-36.2%]，癌症患者为48.7% [95% CI：47.0%-50.4%]。加权多变量泊松回归显示，与非西班牙裔白人相比，非西班牙裔黑人（NHB）和非西班牙裔亚洲人（NHA）接受远程医疗的比例较低（NHB RR：0.87，95% CI：[0.83-0.92]，P<0.01；NHA RR：0.8，95% CI：[0.74-0.86]，P<0.01）。这种种族和族裔差异在癌症患者中消失了。调整后的风险差异（ARD）分析表明，除乳腺癌（NHB ARD：-0.16，95% CI：[-0.27-(-0.05)]，P = 0.01）和淋巴瘤（其他ARD：-0.36，95% CI：[-0.72-(-0.01)]，P = 0.05）外，不同癌症类型的远程医疗使用率下降没有差异。与总体人群相比，癌症患者在远程医疗使用方面的种族和族裔差异有所减少。虽然在两个肿瘤亚组中种族和族裔差异仍然存在，但远程医疗总体上改善了可及性，并可能增加肿瘤护理的公平性。
