Equity and Inclusion in Pediatric Gastroenterology Telehealth: A Study of Demographic, Socioeconomic and Digital Disparities.

Abstract

The purpose of our study is to compare in-person and telehealth pediatric care ambulatory visits for gastroenterology (GI) at the Nemours Children's Health System in the Delaware Valley (NCH-DV) based on geospatial, demographic, socioeconomic, and digital disparities. Characteristics of 26,565 patient encounters from January 2019 - December 2020 were analyzed. U.S. Census Bureau geographic identifiers (GEOIDs) were assigned to each participant and aligned with the American Community Survey (2015-2019) socioeconomic and digital outcomes. Reported odds ratios (OR) are telehealth encounter / in person encounter. GI telehealth usage increased 145-fold in 2020 compared to 2019 for NCH-DV. Comparing telehealth to in-person usage in 2020 revealed that GI patients who required a language translator were 2.2-fold less likely to choose telehealth (individual level adjusted OR (I-ORa) [95% C.I.], 0.45[0.30,0.66], p<0.001). Individuals of Hispanic ethnicity or non-Hispanic Black or African American race are 1.3-1.4-fold less likely to utilize telehealth than non-Hispanic Whites (I-ORa [95% C.I.], 0.73[0.59,0.89], p=0.002 and 0.76[0.60,0.95], p=0.02, respectively). Households in census block-groups (BG) that are more likely to utilize telehealth: have broadband access (BG-OR = 2.51[1.22,5.31], p=0.014); are above the poverty level (BG-OR = 4.44[2.00,10.24], p<0.001); own their own home (BG-OR = 1.79[1.25,2.60], p=0.002); and have a bachelor's degree or higher (BG-OR = 6.55[3.25,13.80], p<0.001). Our study is the largest reported pediatric GI telehealth experience in North America that describes racial, ethnic, socioeconomic, and digital inequities. Advocacy and research for pediatric GI focused on telehealth equity and inclusion is urgently needed.