Disparities in digital access among American rural and urban households and implications for telemedicine‐based services
Open accessAbstract
Purpose: To examine characteristics associated with disparities in digital access (i.e., access to high‐speed Internet via a computer or smartphone) in American rural and urban households given that digital access has a direct impact on access to telemedicine‐based services. Methods: Using the 2019 American Community Survey, we analyzed the proportions of geographic area, race/ethnicity, and socioeconomic status according to device and high‐speed Internet access. Maximum likelihood logit estimators estimated how these factors influenced device and high‐speed Internet access. Findings: Of 105,312,959 households, 32.29% were without a desktop or laptop computer with high‐speed Internet (WDW), 21.51% were without a smartphone with a data plan for wireless Internet (WSW), and 14.02% were without any digital access (WDA). Nonmetropolitan households were significantly more likely to be WDA than metropolitan households (odds ratio [OR] = 1.87; 95% confidence interval [CI]: 1.83‐1.91). Relative to non‐Hispanic Whites, non‐Hispanic Blacks (OR = 1.60; 95% CI: 1.56‐1.64), American Indian or Alaska natives (OR = 2.00; 95% CI: 1.82‐2.19), or Hispanics (OR = 1.70; 95% CI: 1.66‐1.74) were significantly more likely to be WDA. When compared to households with private health insurance coverage, households WDA were significantly more likely to have no insurance (OR = 2.44; 95% CI: 2.36‐2.53) or public insurance coverage (OR = 3.78; 95% CI: 3.70‐3.86). Households with any digital access reported higher income and more family members living at home. Using the same predictors, similar findings were reported for households WDW or WSW. Conclusions: Significant disparities in digital access exist among nonmetropolitan households, racial/ethnic minority households, and lower‐income households. The lack of digital access has implications for the accessibility of health care services via telemedicine and thus could exacerbate health disparities.
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Barriers such as geographic isolation, socioeconomic disadvantage, limited broadband access, and systemic inequities in access to palliative and psychosocial care can contribute to unmet needs for information, skills training, and emotional support.
“Barriers such as geographic isolation, socioeconomic disadvantage, limited broadband access, and systemic inequities in access to palliative and psychosocial care can contribute to unmet needs for information, skills training, and emotional support.6,7,8,9,10”
From Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer (2026) · cites this paper as [8]
The Discussion and Conclusion (page not provided) link rural residence, low income, and limited digital access to reduced access to telemedicine-based health care. They do not address inequities in palliative or psychosocial care, or unmet needs for information, skills training, and emotional support. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAfrican American and rural caregivers have historically had limited access to formal resources and supportive services.
“In addition, African American and rural caregivers have historically had limited access to formal resources and supportive services.”
From Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer (2026) · cites this paper as [8]
The Discussion (page unavailable) reports that non-metropolitan and non-Hispanic Black households had less digital access needed for telemedicine. This supports a narrower point about a barrier to health services, but the paper does not study caregivers or establish historical limits on their access to formal resources and supportive services. (LLM, conf=0.83)
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Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., et al. (2020) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6932a1 · Cited by 2,686 · see citing works
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Archila-Godínez, J. C., Chen, H., Klinestiver, L., Rosa, L., Barrett, T., Henley, S. C., & Feng, Y. (2022) · Foods · doi:10.3390/foods11030355 · Cited by 24 · see citing works
Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer
Odom, J. N., Azuero, A., Taylor, R. A., Young Pierce, J., McGowen, C. L., Pisu, M., Rocque, G., Reed, R. D., Wells, R., Gazaway, S., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.19807
- Authors
- Curtis, M. E., Clingan, S. E., Guo, H., Zhu, Y., Mooney, L. J., & Hser, Y.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Hser, Yih‐Ing
- Venue
- The Journal of Rural Health
- Publisher
- Wiley
- Published
- 2021-08-06
- Volume
- 38
- Issue
- 3
- Pages
- 512-518
- ISSN
- 0890-765X (ISSN-L)
- 1748-0361
- PMC
- PMC9827725
- OpenAlex
- W3193251485
- Cited by
- 161
- References
- 1
- Citations by year
- 2026: 43 · 2025: 41 · 2024: 31 · 2023: 25 · 2022: 18 · 2021: 3
- FWCI
- 8.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Rural Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Drug Abuse (UG1DA049435)
- Topics
- Physical Sciences › Engineering › Media Technology › ICT Impact and Policies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- digital divide, digital access, telemedicine, urban-rural differences, high-speed internet, smartphone access, racial and ethnic disparities, socioeconomic status, health insurance coverage, health disparities
- MeSH terms
- Ethnicity, Health Services Accessibility, Hispanic or Latino, Humans, Minority Groups, United States, Telemedicine, White People, Healthcare Disparities
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