Neighborhood Broadband and Use of Telehealth Among Older Adults: Cross-sectional Study of National Survey Data Linked With Census Data

Background: The COVID-19 pandemic has amplified the role of telehealth in health care delivery. Regional variation in internet access and telehealth use are well-documented, but the effect of neighborhood factors, including the pervasiveness of broadband internet, on older adults' telehealth usage in the context of internet access is not known. Objective: This study aimed to investigate how individual and neighborhood characteristics, including the pervasiveness of neighborhood broadband internet subscription, are associated with engagement in telehealth among older adults with internet access. Methods: In this cross-sectional study, we included 5117 community-living older adults aged >= 65 years, who participated in the 2017 National Health and Aging Trends Study with census tract-level data for participants' places of residence from the American Community Survey. Results: Of an estimated 35.3 million community-living older adults, 21.1 million (59.7%) were internet users, and of this group, more than one-third (35.8%) engaged in telehealth. In a multivariable regression model adjusted for individual- and neighborhood-level factors, age, education, income, and the pervasiveness of neighborhood broadband internet subscription were associated with engagement in telehealth, while race, health, county metropolitan status, and neighborhood social deprivation were not. Among internet users, living in a neighborhood at the lowest (versus highest) tertile of broadband internet subscription was associated with being 40% less likely to engage in telehealth (adjusted odds ratio 0.61, 95% CI 0.42-0.87), all else equal. Conclusions: Neighborhood broadband internet stands out as a mutable characteristic that is consequential to engagement in telehealth.

Automated summary

The COVID-19 pandemic has highlighted the importance of telehealth in healthcare, with regional disparities in internet access and telehealth use. This study aimed to investigate the impact of individual and neighborhood characteristics, including broadband internet availability, on older adults' engagement in telehealth. Results showed that living in neighborhoods with lower broadband internet subscription rates was associated with a lower likelihood of engaging in telehealth among older adults who were internet users.