Abstract

Objective

To explore whether racial/ethnic differences in telehealth use existed during the peak pandemic period among NYC patients seeking care for COVID-19 related symptoms.

Materials and Methods

This study used data from a large health system in NYC – the epicenter of the US crisis – to describe characteristics of patients seeking COVID-related care via telehealth, ER, or office encounters during the peak pandemic period. Using multinomial logistic regression, we estimated the magnitude of the relationship between patient characteristics and the odds of having a first encounter via telehealth versus ER or office visit, and then used regression parameter estimates to predict patients’ probabilities of using different encounter types given their characteristics.

Results

Demographic factors, including race/ethnicity and age, were significantly predictive of telehealth use. As compared to Whites, Blacks had higher adjusted odds of using both the ER versus telehealth (OR: 4.3, 95% CI: 4.0-4.6) and office visits versus telehealth (OR: 1.4, 95% CI: 1.3-1.5). For Hispanics versus Whites, the analogous ORs were 2.5 (95% CI: 2.3-2.7) and 1.2 (95% CI: 1.1-1.3). Compared to any age groups, patients 65+ had significantly higher odds of using either ER or office visits versus telehealth.

Conclusions

The response to COVID-19 has involved an unprecedented expansion in telehealth. While older Americans and minority populations among others are known to be disadvantaged by the digital divide, few studies have examined disparities in telehealth specifically, and none during COVID-19. Additional research into sociodemographic heterogeneity in telehealth use is needed to prevent potentially further exacerbating health disparities overall.

中文翻译：

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冠状病毒大流行期间纽约市用于COVID相关护理的远程医疗用户的特征。

摘要

目的

为了探讨在大流行高峰期寻求COVID-19相关症状护理的纽约市患者中，远程医疗使用中是否存在种族/种族差异。

材料和方法

这项研究使用了来自纽约市大型卫生系统（美国危机的中心）的数据来描述在大流行高峰期通过远程医疗，急诊室或办公室就诊寻求COVID相关护理的患者的特征。使用多项逻辑回归，我们估计了患者特征与通过远程医疗与急诊室或办公室就诊的首次相遇几率之间关系的大小，然后使用回归参数估计来预测患者根据其特征使用不同相遇类型的概率。

结果

人口因素，包括种族/民族和年龄，是远程医疗使用的重要预测。与白人相比，黑人在急诊与远程医疗（OR：4.3，95％CI：4.0-4.6）和办公室就诊与远程医疗（OR：1.4，95％CI：1.3-1.5）方面的调整机率更高。对于西班牙裔与白人，OR分别为2.5（95％CI：2.3-2.7）和1.2（95％CI：1.1-1.3）。与远程医疗相比，年龄在65岁以上的患者使用ER或办公室就诊的几率明显更高。

结论

对COVID-19的回应涉及远程医疗领域的空前扩展。虽然众所周知，美国老年人和少数族裔在数字鸿沟中处于不利地位，但很少有研究专门研究远程医疗方面的差异，而在COVID-19期间没有一项研究。需要对远程医疗使用中的社会人口统计异质性进行更多研究，以防止可能进一步加剧总体健康差异。