PDF(Pubmed)
Abstract：
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.
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.
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.
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.
Neighborhood broadband internet stands out as a mutable characteristic that is consequential to engagement in telehealth.
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.
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.
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.
Neighborhood broadband internet stands out as a mutable characteristic that is consequential to engagement in telehealth.
摘要：
COVID-19大流行扩大了远程医疗在医疗保健服务中的作用。互联网接入和远程医疗使用的区域差异有据可查，但是邻里因素的影响，包括宽带互联网的普及，关于老年人的远程医疗在互联网接入方面的使用情况是未知的。
本研究旨在调查个体和邻里特征，包括社区宽带互联网订阅的普及，与有互联网接入的老年人参与远程医疗有关。
在这项横断面研究中，我们纳入了5117名年龄≥65岁的社区生活老年人，他参加了2017年国家健康和老龄化趋势研究，并使用了美国社区调查中参与者居住地的人口普查道级别数据。
在估计有3530万社区生活的老年人中，2110万(59.7%)是互联网用户，在这个群体中，超过三分之一(35.8%)从事远程医疗。在调整了个体和邻域水平因素的多变量回归模型中，年龄,教育,收入,邻里宽带互联网订阅的普及与远程医疗的参与有关，而种族,健康,县都会区地位,和邻里社会剥夺不是。在互联网用户中，生活在宽带互联网订阅最低(与最高)的社区中，参与远程医疗的可能性降低了40%(调整后的赔率比0.61，95%CI0.42-0.87)，其他一切都平等。
邻里宽带互联网是一个可变的特征，对参与远程医疗至关重要。
本研究旨在调查个体和邻里特征，包括社区宽带互联网订阅的普及，与有互联网接入的老年人参与远程医疗有关。
在这项横断面研究中，我们纳入了5117名年龄≥65岁的社区生活老年人，他参加了2017年国家健康和老龄化趋势研究，并使用了美国社区调查中参与者居住地的人口普查道级别数据。
在估计有3530万社区生活的老年人中，2110万(59.7%)是互联网用户，在这个群体中，超过三分之一(35.8%)从事远程医疗。在调整了个体和邻域水平因素的多变量回归模型中，年龄,教育,收入,邻里宽带互联网订阅的普及与远程医疗的参与有关，而种族,健康,县都会区地位,和邻里社会剥夺不是。在互联网用户中，生活在宽带互联网订阅最低(与最高)的社区中，参与远程医疗的可能性降低了40%(调整后的赔率比0.61，95%CI0.42-0.87)，其他一切都平等。
邻里宽带互联网是一个可变的特征，对参与远程医疗至关重要。
