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Evaluating the Continuity of Telehealth Usage Among Hispanics: The Impact of Language Barriers
Zhiyu Qian1,2, Hanna Zurl1,2, Stephan M Korn1,2,3
1Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Telehealth use surged during the COVID-19 pandemic, improving access and convenience for many but declined as pandemic incentives waned. Hispanics, who face socioeconomic and language barriers, may experience unique challenges in maintaining telehealth use.
Objective:
To evaluate differences in telehealth utilization trends between Hispanic and non-Hispanic populations and assess the role of language barriers.
Design:
Retrospective analysis of National Health Interview Survey (NHIS) data (2020-2023) using multivariable logistic regression models with interaction terms for Hispanic ethnicity and survey year. Marginal effects and incremental usage changes were assessed, with secondary analysis in 2023 survey data where primary language was available.
Participants:
In total, 103,446 adult NHIS respondents from 2020 to 2023 who answered the telehealth utilization question, weighted to represent 221 million US residents.
Main Measures:
Telehealth utilization rates by ethnicity and survey year, adjusted odds for utilization among Hispanic versus non-Hispanic participants, and the impact of primary language in 2023.
Key Results:
Telehealth utilization was consistently lower among Hispanics (aOR 0.84, 0.89, and 0.78 in 2020, 2021, and 2023, respectively; all p < 0.05). Adjusted probability of telehealth use peaked in 2021 for both groups: 35% among Hispanics and 38% among non-Hispanics and remained consistently lower among Hispanics across all survey years, declining to 23% and 28% respectively by 2023. Marginal effects revealed a steeper decrease in telehealth use among Hispanics from 2021 to 2023 compared to non-Hispanics (aOR = 0.62 vs. aOR = 0.53; p = 0.018). Secondary analysis in 2023 indicated that non-English speakers were significantly less likely to utilize telehealth services (aOR 0.77; 95%CI 0.66-0.90).
Conclusions:
Hispanics utilized telehealth less consistently than non-Hispanics, with sharper declines following the 2021 peak. Language barriers appear to partly account for these disparities. Equitable telehealth adoption would benefit from strategies addressing Hispanic populations' specific needs and sustainable reimbursement policies to support infrastructure and initiatives.
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