The impact of telemedicine on racial and ethnic disparities in oncologic care during the COVID-19 pandemic.

Abstract

Codification of COVID-19-era use of telemedicine as a permanent feature of US healthcare has been discussed as it may increase accessibility and equity. This study assesses whether telemedicine is associated with improved differential access to cancer care for racial and ethnic minorities. We conducted a cross-sectional analysis of the National Health Interview Survey from July 2020 to December 2021 and estimated prevalence of telemedicine utilization in both the study population (N=46,799) and in a subgroup of cancer patients (N=7,784). Complex survey-weighted multivariable Poisson regression identified patient-level predictors and estimated risk ratios (RR) for telemedicine receipt. Two-way interaction between cancer type and race and ethnicity assessed effect modification. Telemedicine prevalence was 35.5% [95% CI: 34.8%-36.2%] for the overall study population and 48.7% [95% CI: 47.0%-50.4%] for cancer patients. Weighted multivariable Poisson regression revealed that non-Hispanic Black (NHB) and non-Hispanic Asian (NHA) individuals had lower receipt compared to non-Hispanic White (NHB RR: 0.87, 95% CI: [0.83-0.92], P<0.01; NHA RR: 0.8, 95% CI: [0.74-0.86], P<0.01). This racial and ethnic disparity disappeared among cancer patients. Adjusted risk difference (ARD) analysis indicated no difference in decreased telemedicine utilization by cancer type except for breast cancer (NHB ARD: -0.16, 95% CI: [-0.27-(-0.05)], P=0.01) and lymphoma (Other ARD: -0.36, 95% CI: [-0.72-(-0.01)], P=0.05). Racial and ethnic disparities in telemedicine utilization decreased for cancer patients compared to the overall population. While racial and ethnic disparities persisted in two oncologic subgroups, telemedicine overall improved access and may increase equity in oncologic care.