Telehealth utilization among adults with cognitive difficulty: Evidence from the National Health Interview Survey, 2020-2023.

Gonzalez Villarreal, Eduardo; Hong, Young-Rock; Breithaupt, Andrew; Kripalani, Sia; Kiselica, Andrew; Kulshreshtha, Ambar · Int J Med Inform · 2026

cross_sectional · Level IV

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Abstract

Telehealth may expand care access by reducing transportation barriers, yet little is known the extent to which cognitive difficulties impact telehealth usage. We analyzed cross-sectional data from the National Health Interview Survey (NHIS) from 2020 to 2023. Multivariate logistic regression assessed the association between cognitive difficulty and telehealth utilization, controlling for age, sex, race/ethnicity, education, insurance, and year. Among 72,611 adults (mean age 54.6 years ± 18.5 years, 57.0 % female, 11.1 % African American), telehealth use was higher among individuals with significant cognitive difficulty (51.1 %) than those without (32.7 %) (OR = 2.41, 95 % CI: 2.16-2.69). Age modified this association (interaction p < 0.001), with a weaker effect among adults ≥ 50 (OR = 1.33, 95 % CI: 1.26-1.40) than among younger adults (OR = 1.71, 95 % CI: 1.63-1.80). Participants with greater cognitive difficulty were more likely to use telehealth, though the association was attenuated in adults > 50 years.