Telemedicine and Healthcare Disparities: A cohort study in a large healthcare system in New York City during COVID-19

Rumi Chunara, an assistant professor in the Department of Computer Science and Engineering at NYU Tandon,  and in the Department of Biostatistics at NYU School of Global Public Health, was corresponding author.

Through the COVID-19 pandemic, telemedicine has become a necessary entry point into the process of diagnosis, triage and treatment. Racial and ethnic disparities in health care have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted. The researchers assessed disparities in those who access healthcare via telemedicine for COVID-19.

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

The collaborators included Yuan Zhao of the NYU School of Global Public Health; Ji Chen of the NYU Grossman School of Medicine; Katharine Lawrence, Paul A. Testa and Devin M. Mann of NYU Langone Health; and Oded Nov, professor in the Department of Technology Management and Innovation at NYU Tandon. 

Controlling for individual and community-level attributes, the researchers found that Black patients had 0.6 times the adjusted odds 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 (while they were more likely for white patients when considering in-person and telemedicine visits).

While the study reports that Black patients are not accessing care through telemedicine (versus by in-person visits to emergency department and physician’s offices) at the same rate as white patients, it notes increased uptake by young, female Black patients. Mean income and decreased mean household size of patients' home zip code were also significantly related to telemedicine use.

The team reports that 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.

The research, which was supported by a generous grant from the National Science Foundation,