Disparities in telehealth utilization between US rural and urban areas during the COVID-19 pandemic

Purpose: During the COVID-19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural-urban differences in telehealth utilization during the early part of the COVID-19 pandemic.

Methods: Individual-level data from the National Health Interview Survey 2020-2021 (age ≥18) were analyzed for this study. The Propensity Score Matching method with multivariable Ordinary Least Square was used to analyze 2 outcome variables-(1) having a medical appointment by video or phone in the past 12 months and (2) having a virtual one for reasons related to the pandemic. Event study models were analyzed to understand the trend of telehealth utilization throughout 6 quarters of the pandemic. Subgroup analysis by health insurance, age, sex, race, citizenship, and disability status was performed to identify underlying disparities between rural and urban residents.

Findings: Analysis reveals that rural respondents (N = 6,984) were 8.7 percentage points (P<.001) less likely than urban respondents (N = 40,207) to have a medical appointment by video or phone. Rural residents were 8.1 percentage points (P<.001) less likely to have had a virtual medical appointment because of reasons related to the COVID-19 pandemic than urban users. The event study showed that rural-urban telehealth utilization disparities persisted throughout the pandemic. Subgroup analysis revealed significant rural-urban disparities in telehealth utilization by demographic characteristics.

Conclusions: Results demonstrate that rural residents were less likely than urban residents to utilize telehealth services during the COVID-19 pandemic, highlighting concerns about access to care for rural residents.