Abstract

Objective

Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19.

Materials and Methods

Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results.

Results

Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58–0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients.

Discussion

There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use.

Conclusion

Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection—many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.

中文翻译：

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远程医疗和医疗保健差异：COVID-19 期间纽约市大型医疗保健系统的一项队列研究。

摘要

客观的

通过 2019 年冠状病毒病 (COVID-19) 大流行，远程医疗成为诊断、分诊和治疗过程的必要切入点。医疗保健方面的种族和民族差异在 COVID-19 中得到了很好的记录，涉及感染风险和入院后的住院结果，在这里，我们评估了通过 COVID-19 远程医疗获得医疗保健的人的差异。

材料和方法

2020 年 3 月 19 日至 4 月 30 日期间纽约大学 Langone Health 患者的电子健康记录数据用于就就诊类型（远程医疗或面对面）、疑似 COVID 诊断和 COVID 检测结果进行描述性和多级回归分析.

结果

控制个人和社区层面的属性，黑人患者通过远程医疗获得护理的调整几率是白人患者的 0.6 倍（95% CI：0.58-0.63），尽管在年轻患者的推动下，他们越来越多地使用远程医疗进行紧急护理和女性人口。黑人与白人远程医疗患者相比，COVID 诊断的可能性要大得多。

讨论

黑人患者获得远程医疗存在差异，但年轻女性黑人患者的接受度有所增加。邮政编码的平均收入和减少的平均家庭规模也与远程医疗的使用显着相关。

结论

远程医疗访问差异反映了面对面医疗访问的差异。不同使用的根源很复杂，反映了个人、社区和结构因素，包括它们的交叉点——其中许多是由系统性种族主义造成的。有关通过远程医疗表现出来的差异的证据可用于为工具设计和促进数字健康公平的系统性努力提供信息。