During the early days and months of the COVID-19 pandemic, healthcare facilities experienced a decline in non-COVID-related visits, while interest in telehealth services for both adults and pediatric patients increased. However, a new study from the University of Alabama at Birmingham School of Public Health in PLOS ONE found disparities including race and location in telehealth usage among children insured by Alabama Medicaid.

This retrospective observational study examined administrative data provided by Alabama Medicaid claims from enrollees younger than 19 years of age submitted from March - December 2020. The study reveals that Non-Hispanic Black children were 80% as likely, Hispanic children were 55% as likely, and Asian Children were 46% as likely to have used telehealth services in comparison to Non-Hispanic White children. Results also reveal that pediatric enrollees in larger rural and isolated areas were significantly less likely to use telehealth than those in urban areas.

“The results show us that characteristics of area level social determinants of health, whether that’s residing in a zip code of high poverty or with one poor broadband connectivity, influence whether children will be more likely to use telehealth services,” said Bisakha Sen, Ph.D., professor and Blue Cross Blue Shield Endowed Chair in the UAB School of Public Health and joint first author. “In addition to the suggestion that greater attention must be paid to addressing race and ethnicity disparities in accessing telehealth services, anecdotal evidence also suggest that wi-fi connectivity is a major barrier to accessing virtual health services. This is one of the first papers that analyzes whether broadband plays a role in pediatric use of telehealth after accounting for rurality and area-level poverty.”

The researchers believe that these findings underscore the need to address race and ethnicity disparities to improve access to telehealth services for pediatric patients, and that further research is required to both understand the reasons for these disparities and to develop interventions to address them. However, the relatively low telehealth use among Hispanic and Asian patients suggest that language and communication barriers may be a significant impediment to telehealth use as well, and providers may require guidance and resources to include translators in telehealth visits. Zip code-level broadband access was not associated with telehealth use, suggesting that at least among Medicaid enrollees, variations in broadband access may not be a driver of telehealth use or lack thereof.

Investigators on this study include the of Department of Health Policy and Organization’s Bisakha Sen, Ph.D., professor; Jillur Rahim, statistician II; Julie McDougal, MAE, Program Director II; Pradeep Sharma, MS, MBA, Scientist II; Anne Brisendine, DrPH, CHES, Assistant Professor; Van Nghiem, PhD, Assistant Professor and David Becker, PhD, Associate Professor; and Nianlan Yang, Statistician I in the UAB Department of Family and Community Medicine; Ye Liu, DrPH Student in the Department of Health Policy and Organization and Statistician II in the UAB Division of Clinical Immunology and Rheumatology.