Digital Divide Among U.S. Adults with and without Cancer: Prevalence and Associated Factors

Digital technologies have transformed healthcare, yet disparities persist, particularly among older adults and individuals with cancer. The digital divide encompasses not only access but also challenges in electronic communication and cognitive engagement, affecting health equity. This study examined the prevalence of three digital divide dimensions (Access, E-communication, and Cognitive Gaps) among U.S.adults with and without cancer and assessed their associations with sociodemographic factors, clinical characteristics, and self-rated health. Cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6; N = 5,808) were analyzed using survey-weighted methods. Generalized linear models examined sociodemographic and clinical predictors of digital gaps, and survey-weighted linear regression assessed associations with self-rated health. The E-communication Gap was most prevalent (36.2%), followed by the Cognitive Gap (13.3%) and Access Gap (4.7%). Older adults had higher prevalence across all gaps. Individuals with cancer showed higher Access and Cognitive Gaps than those without cancer. Older age and lower education were consistent predictors, and comorbidities increased the likelihood of Access Gap among adults with cancer. The Cognitive Gap reflecting low confidence in finding health information online was significantly associated with poorer self-rated health overall (β̂ = -0.18; 95% CI [- 0.30, - 0.06]) and among older adults. The digital divide is multidimensional and disproportionately affects older adults and individuals with cancer. Cognitive-related digital barriers may play an important role in perceived health, highlighting the need for interventions that strengthen digital literacy and support equitable participation in digital health.