Racial Disparities in Telemedicine Uptake during the COVID-19 Pandemic Among Patients with Hematologic Malignancies in the United States

ABSTRACT

Background/objectives: The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine;whether there are differences in these trends across racial groups is unknown. This study investigated potential racial disparities in visits during the pandemic for patients with documented active treatment for hematologic malignancies. Methods: We used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, at least 18 years old at initial diagnosis, and documented race in the EHR as Black/African American or White were included. Patients were categorized into treatment types within lines of therapy Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g. no documented therapy, surveillance). We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual monthly visit rates (expected rates if the pandemic did not occur) between March 2020 - February 2021 for all diseases combined, for each disease, each treatment type, and each race. Differences between projected and actual monthly visit rates during the pandemic period were considered significant and related due to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. We used cross-correlation analysis to test for significant differences in visit rates between Black and White patients. Results: The analysis included 17,621 patients (2,225 Black, 15,396 White) 3,041 AML, 2,715 DLBCL, 1,558 FL, 1,511 MCL, 3,813 CLL and 5,244 MM (1,166 Black, 4078 White). Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18% statistically significant reduction (95% PI 9.9% - 25%) in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 (95% PI 1.8 - 2.2) visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories (Figure A & B) (t = 9.5, p < 0.01), AML inpatient treatments (t = 2.4, p = 0.04), MM orals (Figure C) (t = 6.0, p < 0.01) and MM inpatient treatments (Figure D) (t = 2.3, p = 0.04). Conclusions: A tradeoff in reductions in in-person visits and uptake of telemedicine use was observed overall. White patients had significantly higher telemedicine uptake compared with Black patients for both oral and inpatient treatments. In-person visit rates for Black patients were unchanged regardless of treatment category. These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors. Figure. Trends over time in telemedicine visit rates for White patients (blue line) and Black patients (black line) [Formula presented] Disclosures Neparidze Eidos Therapeutics Membership on an entity's Board of Directors or advisory committees;GlaxoSmithKline Research Funding;Janssen Research Funding. Lau Flatiron Health Inc Current Employment;Roche Current equity holder in publicly-traded company. Wang Flatiron Health Current Employment;Roche Current equity holder in publicly-traded company. Davidoff Amgen Consultancy;AbbVie Other Family member consultancy. Huntington Bayer Honoraria;Servier Consultancy;Pharmacyclics Consultancy, Honoraria;Thyme Inc Consultancy;Genentech Consultancy;AbbVie Consultancy;SeaGen Consultancy;Celgene Consultancy, Research Funding;Flatiron Health Inc. Consultancy;DTRM Biopharm Research Funding;TG Therapeutics Research Funding;AstraZeneca Consultancy, Honoraria;Novartis Consultancy. Calip Flatiron Health Inc Current Employment;Roche Current equity holder in publicly-traded company;Pfizer Research Funding. Shah AstraZeneca Research Funding;Seattle Genetics Research Funding;Epizyme Research Funding. Stephens Adaptive Membership on an entity's Board of Directors or advisory committees;Celgene Consultancy;Abbvie Consultancy;CSL Behring Consultancy;Novartis Research Funding;Karyopharm Membership on an entity's Board of Directors or advisory committees, Research Funding;JUNO Research Funding;Mingsight Research Funding;AstraZeneca Consultancy;Innate Pharma Membership on an entity's Board of Directors or advisory committees;Beigene Membership on an entity's Board of Directors or advisory committees;TG Therapeutics Membership on an entity's Board of Directors or advisory committees;Epizyme Membership on an entity's Board of Directors or advisory committees;Arqule Research Funding. Miksad Flatiron Health Inc Current Employment, Current holder of individual stocks in a privately-held company;Roche Current equity holder in publicly-traded company. Parikh Onc.AI Current holder of individual stocks in a privately-held company;Humana Honoraria, Research Funding;Flatiron Health Inc Honoraria;Thyme Care Honoraria;Nanology Honoraria;GNS Healthcare Current holder of individual stocks in a privately-held company. Takvorian Genentech Consultancy;Pfizer Research Funding. Seymour Janssen Membership on an entity's Board of Directors or advisory committees;Roche Current equity holder in publicly-traded company;Pharmacyclics Membership on an entity's Board of Directors or advisory committees;Flatiron Health Inc Current Employment;Karyopharm Honoraria, Membership on an entity's Board of Directors or advisory committees.