ASPO Abstracts
Disparities in Telehealth for Oncology Encounters During COVID as a function of Race, Ethnicity, and Insurance Type
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
PurposeSince it is unclear whether telehealth increases underserved patients' access to cancer care or decreases it due to a digital divide, we studied whether telehealth use differs in relation to patients' racial and ethnic background and primary insurance.Methods We used Northwestern Medicine's (NM) enterprise data warehouse to identify adult cancer patients with at least one oncology encounter between 6/1/2020 and 5/31/2021 at one of NM's 151 Chicago area cancer clinics. Encounters were classified as telehealth or in-person and patients' age, sex, race, ethnicity, and primary insurance were extracted. Logistic regression analyses, controlling for age, estimated the odds of having any telehealth oncology visit for Asian, Black, and Hispanic patients compared to non-Hispanic White, and for primary insurance from Medicare, Medicaid, and self-pay compared to private plan. Proportion of total oncology encounters completed by telehealth was contrasted by patient race, ethnicity, and insurance type via incidence rate ratios (IRR).ResultsOf 51,135 eligible patients, 43% had at least one telehealth encounter during the study period. The odds ratio (OR) for having a telehealth encounter was greater for Asian (OR: 1.11; CI: 1.01, 1.22) and Black (OR:1.33; CI: 1.25, 1.42) than non-Hispanic White patients. Primary insurance from Medicare (OR:1.35; CI: 1.28, 1.42) and Medicaid (OR: 1.37; CI: 1.24, 1.51) resulted in greater odds of having a telehealth encounter compared to private plans. Among telehealth users, Black (IRR: 0.97) and Hispanic (IRR: 0.95) patients received proportionally less telehealth than White patients, and those primarily insured by Medicare (IRR: 0.97) and Medicaid (IRR: 0.93) received proportionally less telehealth than those in private plans.ConclusionsAmong adults receiving cancer care at NM during COVID, racial minorities and publicly insured patients showed increased odds of accessing any telehealth oncology care, but received a smaller proportion of total cancer care via telehealth compared to white or privately insured patients. This paradox raises questions regarding the nature of encounters, type of provider who delivered care, patient and oncologist telehealth preferences, and whether utilization patterns will persist post-COVID.
Keywords: telemedicine, race, healthcare disparity, health insurance, COVID