Racial/ethnical disparities in the utilization of telehealth services among medicare beneficiaries with atrial fibrillation before the covid-19 pandemic

ABSTRACT

Introduction: Telemedicine facilitates continued access to care for management of chronic diseases while preventing exposure to health care facilities;however, reliance on telemedicine may exacerbate disparities based on the persistent digital divide. Documenting racial variation in the uptake of telemedicine is crucial to understand the potential aggravation of health care access inequities in the era of COVID-19. We used a nationally representative sample of Medicare beneficiaries with atrial fibrillation (AF) to quantify racial disparities in telehealth utilization before the COVID-19 pandemic. Hypothesis: Black patients are less likely to be engaged with telehealth services than White patients. Methods: Using a 5% random sample of Medicare claims data, we extracted telehealth visits in 2016 using modifiers GT, 95, and GQ and place of service code 2 in medical claims. We used multivariate Poisson models to estimate incidence rate ratios (IRR) comparing the number of telehealth visits across White, Black, and patients of other races. Results: Among 135,164 patients with AF, 404 (0.3%) had a total of 1420 telehealth visits in 2016.After adjusting for age, sex, AF duration, rurality, CHA2DS2-VASc score, Alzheimer's disease, use of direct oral anticoagulants and warfarin, and receipt of low-income subsidy, Black were 60% lesslikely than White to receive telehealth services (IRR 0.4 [0.3, 0.5]), and the 'others' group were 70%less likely to receive telehealth services (0.3 [0.2, 0.5]). Among rural residents, however, the racialdifference in telehealth use was only seen in Black (0.4 [0.2, 0.6]) but not in the 'others' group (0.9[0.6, 1.4]). The gap in telehealth use between White and Black was larger among those with higherCHA2DS2-VASc scores ( Figure) . Conclusion: Before the COVID-19 pandemic, tele health service use was rare overall in patients with AF. However, Black patients, especially those with increased stroke risk, were still significantlyless likely to have access to telemedicine than White patients.