Neighborhood Broadband and Older Adults’ Use of Telehealth: Cross-sectional Study of National Survey Data Linked with Census Data (Preprint)

BACKGROUND The COVID-19 pandemic has amplified the important role of telehealth to safe continuity of care. Regional variation in internet access and telehealth use are well-documented, but how neighborhood factors, including pervasiveness of broadband internet, affects older adults’ telehealth in the context of internet access is not known. OBJECTIVE To assess how individual and neighborhood characteristics, including pervasiveness of neighborhood broadband internet subscription, affect engagement in telehealth among older adults with internet access. METHODS Cross-sectional study of 5,117 community-living older adults who participated in the 2017 National Health and Aging Trends Study with census-tract level data for participants’ place of residence from the American Community Survey. RESULTS Of an estimated 35.3 million community-living older adults, 21.1 million (59.7%) were internet users, and of this group, more than 1 in 3 (35.8%) engaged in telehealth. In a multivariable regression model that adjusted for individual and neighborhood-level factors, age, education, income, and pervasiveness of neighborhood broadband internet subscription were associated with engagement in telehealth: race, health, county metropolitan status, and neighborhood social deprivation were not. Among internet users, living in a neighborhood at the lowest (versus highest) tertile of broadband internet subscription was associated with being 40% less likely to engage in telehealth (aOR=0.60, 95% CI: 0.42, 0.87), all else equal. CONCLUSIONS Neighborhood broadband internet stands out as a mutable characteristic that is consequential to telehealth participation.