Minorities, ASCVD Patients Go Online Less in US Survey, With Telehealth Implications

August 20, 2020

Patients with atherosclerotic cardiovascular disease (ASCVD) are 26% less likely to use the internet than the broad population in the United States, and even fewer Black and Hispanic ASCVD patients go online, suggests a national survey that also saw significantly less internet use among the minority groups than among White people.

"Efforts are needed to mitigate these disparities to ensure equitable care delivery at a time when telehealth services have become important for the provision of longitudinal cardiovascular care," write the authors of the study, led by Mahmoud Al Rifai, MD, MPH, Baylor College of Medicine, Houston, in their report published August 11 in the American Journal of Cardiology.

Patients with ASCVD go online less, they propose, probably because they skew older than the general population, exacerbating the generational divide in regular internet use. Black and Hispanic people are also more likely than the population as a whole to have ASCVD and to be stricken with COVID-19, when reliance on the internet for interaction with clinicians has increased.

The survey was based on 2016 and 2017 data from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based questionnaire administered by the Centers for Disease Control and Prevention (CDC) to a random sample US adults in the community, the group notes.

Internet use was noted by a "yes" answer to the question, "Have you used the internet in the past 30 days?" Presence of ASCVD was also self-reported and included "coronary heart disease or myocardial infarction or stroke."

Of the 910,655 respondents, 37% were older than 45 years, 51% were women, 63% were White, 12% were Black, 17% were Hispanic, and 9% self-reporting ASCVD.

At the time, about 84% of the US population reported internet use as it was defined, but the rate was only 63% of those reporting ASCVD. The rate was 66% among White respondents, 47% among Black respondents, and 50% among Hispanic respondents, the group reported (P < .001 for all differences).

In adjusted analysis, people who self-reported ASCVD showed an odds ratio (OR) of 0.74 (95% CI, 0.71 - 0.77) for internet use, compared with the broad US population. The two minority groups were significantly less likely than White people to report internet use as defined in the survey:

  • OR, 0.36 (95% CI, 0.33 - 0.40) for Black respondents

  • OR, 0.45 (95% CI, 0.40 - 0.52) for Hispanic respondents

"The provision of telemedicine necessitates broad and equitable access to the internet," with cost probably "the largest barrier to uniform access," the group writes. "With recent job losses and unemployment now affecting at least 15% of the US population, access to internet may worsen."

Al Rifai had no relevant disclosures. Disclosures for the other authors are in the report.

Am J Cardiol. Published online August 11, 2020. Full text

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