Abstract 10423: US Counties With Low Broadband Internet Access Have a High Burden of Cardiovascular Risk Factors, Disease, and Mortality

Abstract

Introduction: Nationwide broadband internet access is a major federal priority. The bipartisan infrastructure law invested $65 billion into equitable broadband expansion, driven by concern that broadband access is a social determinant of health. However, the difference in health outcomes between counties with low vs. higher broadband access has not been studied, and could provide insights on the implications of expansion efforts. Objectives: We evaluated demographic factors, health resources, and cardiovascular disease (CVD) burden in counties with low broadband access compared to those with higher access. Methods: We assessed all 3,142 US counties in 2019 and identified those with low broadband access, defined as <50% of residents having access to internet subscriptions with speeds > 25 Mbps download / > 3 Mbps upload, using the US Broadband Usage Percentages Dataset. We linked these data to the American Community Survey, American Health Resource File, PLACES, and CDC WONDER for demographic, health resource, CVD risk factor and outcomes, and mortality data respectively. Results: There were 461 counties with low broadband access and 2,650 counties with higher access. Compared to those with higher broadband access, counties with low broadband access had lower high school graduation rates (47% vs 54%, p<0.001) and were more likely to be rural (86% vs 59%, p<0.001). Low-access counties had fewer primary care physicians and fewer cardiologists, but similar hospital beds per capita ( Table ). These counties had higher rates of CVD risk factors, coronary artery disease, and stroke, as well as higher age-adjusted rates of CVD mortality and all-cause mortality ( Table ). Conclusions: Counties with low broadband access have lower access to physicians and significantly higher rates of CVD risk factors, CVD, and CVD mortality. Expanding access to broadband internet and telemedicine has the potential to improve access to care and reduce disparities in CVD outcomes.