Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.

Abstract

514 Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.