Abstract
OBJECTIVE: The study objective was to assess sociodemographic disparities in telehealth use among patients in an urban adult rheumatology clinic during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this retrospective cohort study, patient-level sociodemographic data associated with all rheumatology visits in the following two periods were reviewed: pre-COVID-19 (March 1, 2019 to February 28, 2020) and COVID-19 (April 1, 2020 to March 31, 2021). Data were extracted from the electronic health record. Multivariable logistic regression analyses were performed to determine sociodemographic factors associated with video visits during the COVID-19 period. RESULTS: In the pre-COVID-19 period, 1503 patients completed 3837 visits (100% in person). In the COVID-19 period, 1442 patients completed 3406 visits: 41% in person, 30% video, and 29% telephone only. Several factors were associated with decreased video use: preference for Spanish language (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.15-0.47) or other non-English languages (aOR 0.34, 95% CI 0.21-0.55), Black or African American race/ethnicity (aOR 0.50, 95% CI 0.35-0.73), Medicaid payer, and increasing age. CONCLUSION: Decreased video visit use among rheumatology patients was associated with non-English language preference, minority race/ethnicity, increasing age, and indicators of low income. Rapid deployment and expansion of telehealth during the COVID-19 pandemic likely has improved access for some but widened preexisting disparities for others. As medical care evolves toward ongoing digital care delivery, clarifying and addressing causes of telehealth disparities is essential for delivering equitable health care.