The Relationship Between Broadband Internet Adoption and Self-reported Diabetes Prevalence in US Counties

The Internet provides many populations access to virtual health services, social resources, and health education. It is not understood how lack of household Internet adoption impacts the risk of negative health outcomes. Our study aimed to examine the relationship between Internet adoption and self-reported diabetes prevalence in US counties, while controlling for social determinants of health. This cross-sectional, retrospective study used US national county-level data obtained from the 2021 American Communities Survey and the 2021 Behavioral Risk Factors Surveillance System. Analysis included descriptive statistics, two-stage linear regression, and machine learning. A total of 3076 counties were analyzed. The results show that, in 2021, Internet adoption had a significant inverse relationship ( β  = -.20, P  < .001) with diabetes prevalence in US counties while controlling for other social determinants of health. The results suggest that as household Internet adoption rates increase, diabetes prevalence decreases, at the county level. The relationships between social characteristics, Internet adoption, and health behaviors on diabetes prevalence in US counties warrant future research including individual-level validation and integration of health behaviors related to diabetes risk. These findings provide evidence of Internet adoption as a social determinant of health.