Telehealth and Mammogram Receipt in Urban and Rural Women: Quasi-Experimental and Spatial Analyses

To examine the association between telehealth utilization and mammogram receipt by rurality, and to characterize geographic patterns of concurrent increases in telehealth and mammography use in urban and rural communities.

The sample included women, aged 50 years or older, receiving services in primary care or gynecology/women's health practices at MultiCare Health System from 2018 to 2023. For the difference-in-difference (DiD) analyses, women who had only in-person visits during the prepandemic period but had at least one telehealth visit in each year of the postpandemic period were defined as the treatment group. Women who had only in-person visits during both pre- and postpandemic periods were defined as the control group. For the spatial analyses, we analyzed ZIP Codes in which both telehealth and mammography utilization increased from 2018-2019 to 2020-2022.

DiD analyses suggested that telehealth use was significantly associated with a greater probability of mammogram receipt among rural women; however, this association was not found in urban women. Spatial analyses indicated that concurrent increases in telehealth and mammogram use occurred in both rural and urban settings but exhibited greater spatial concentration in urban areas and comparatively more dispersed patterns across rural ZIP Code Tabulation Areas.

The findings suggest that telehealth may be particularly beneficial for improving mammography screening among rural individuals, who typically experience greater structural barriers to accessing health care. While urban areas may exhibit clustered patterns driven by interconnected care systems, rural areas may experience more diffuse but meaningful gains as telehealth expands access across large geographic distances.