Healthcare unplugged: Disparities in broadband internet and health facility access among US counties.

Abstract

Amid the COVID-19 pandemic, telemedicine emerged as a promising solution for early disease detection. However, access may remain limited in communities with reduced access to outpatient health facilities key for timely screening. Here, we correspond broadband internet access with access to health facilities and elucidate rural-urban disparities. For 3,133 US counties, we extracted data on the population density of outpatient care centers, diagnostic labs, and nursing/residential care (2017 National Neighborhood Data Archive), broadband access stratified based on the median percentage (9.8%) of households without broadband (2022 FCC Mapping Broadband Health in America), urbanicity level, and sociodemographic covariates (2022 American Community Survey). Two-sample t-tests substantiated the association between broadband access and facility densities. Multivariable linear regressions quantified the association between broadband access and facility densities, adjusting for sociodemographic covariates, and geographical heatmaps visualized trends in broadband access, urbanicity level, poverty rate, and facility densities. Heatmaps revealed that regions with limited healthcare facilities-particularly the Great Plains and Southwest-overlap with areas of low broadband coverage. Compared to counties with high broadband access, those with low access had fewer outpatient care centers (mean 10.46 vs. 11.91 per 100,000 residents, P < 0.001) and diagnostic labs (mean 1.91 vs. 3.95 per 100,000 residents, P < 0.001). They also demonstrated higher poverty rates, older populations, increased rurality, and lower educational attainment, employment, and insurance (all P < 0.001). Multivariable regression confirmed that declining broadband access corresponds with lower densities of outpatient care centers (β = -0.045), diagnostic laboratories (β = -0.024), and nursing/residential care facilities (β = -0.089; all P < 0.001). Ultimately, US communities with the fewest physical health resources-particularly in rural, low-income counties-are also less likely to have broadband access. Addressing this inequity necessitates coordinated investment in broadband expansion and targeted health services deployment.