Black and Latino/a/x Ethnicity, Low SES Associated With Lower Engagement in Videoconferencing for GI Visits

A female doctor offers an unrecognizable female patient advice during a telemedicine appointment.
Investigators sought to examine the patient characteristics associated with completing in-person and telemedicine visits for GI care.

Black and Latino/a/x ethnicity, low socioeconomic status (SES), nonprivate commercial insurance, and advanced age are independently associated with lower odds of engaging in videoconferencing compared with telephone or in-person visits (IPV) for gastroenterology (GI) care, according to a study in Gastroenterology.

Investigators sought to examine the patient characteristics associated with completing IPV and telemedicine visits at a large, tertiary care center in Massachusetts from April 1, 2020, through May 15, 2020. Visits in the same period in 2019 comprised the control group.

A total of 6120 completed GI clinic visits were recorded (3589 from 2019 and 2531 from 2020). All visits in 2019 were IPV, while 9 in 2020 were IPV and thus excluded. A total of 2522 telemedicine visits were completed (958 videoconferencing and 1564 telephone). Participants’ mean age was 52.0 ± 17.8 years, 4060 (66.4%) were women, and 4626 (75.7%) identified as White, 433 (7.09%) as Black, 573 (9.38%) as Latino/a/x, and 200 (3.28%) as Asian.

Univariate analyses showed that participants in the videoconferencing group were significantly younger than those in the IPV group (46.0 ± 17.0 vs 53.1 ± 17.8 years; P <.0001). The videoconferencing group also had a lower proportion of Black (3.48% vs 7.02%; P <.0001) and Latino/a/x (3.48% vs 9.92%; P <.0001) patients, more private commercial insurance coverage (74.1% vs 54.6%; P =.0001), and higher income by zip code ($75,850 vs $72,292; P <.0001) compared with the IPV group.

Multivariable analysis showed that Black ethnicity (adjusted odds ratio [aOR], 0.56; 95% CI, 0.38-0.82; P =.039) and Latino/a/x ethnicity (aOR, 0.43; 95% CI, 0.29-0.63; P =.0009), living in zip codes in the lowest quartile of income (aOR, 0.72; 95% CI, 0.58-0.90; P =.017), age >60 years (aOR, 0.53; 95% CI, 0.43-0.65; P <.0001), use of public insurance only (aOR, 0.51; 95% CI, 0.40-0.65; P <.0001) or public insurance with private supplement (aOR, 0.64; 95% CI, 0.51-0.80; P =.035), and new patient appointments (aOR, 0.72; 95% CI, 0.60-0.85; P =.0002) were independently associated with lower odds of completing videoconferencing compared with IPV.

Multivariable logistic regression also demonstrated that Black (aOR, 1.53; 95% CI, 1.21-1.94; P =.016) and Latino/a/x (aOR, 1.32; 95% CI, 1.07-1.66; P =.034) ethnicity were independently correlated with higher odds of engaging in telephone conferencing compared with IPV.

Regarding a subgroup analysis of telemedicine patients only in 2020, telephone patients had a higher mean age (53.5 ± 17.6 vs 46.0 ± 17.0 years; P <.0001) and were more likely to be Black (9.8% vs 3.5%; P <.0001) and Latino/a/x (12.2% vs 3.5%; P <.0001) compared with videoconferencing patients.

According to an adjusted multivariable model, Black (aOR, 2.95; 95% CI, 1.94-4.48; P =.015) and Latino/a/x (aOR, 3.12; 95% CI, 2.07-4.71; P =.005) ethnicity, lowest quartile of income by zip code (aOR, 1.44; 95% CI, 1.11-1.88; P =.054), age >60 years (aOR, 2.05; 95% CI, 1.61-2.63; P <.0001), public insurance only (aOR, 1.96; 95% CI, 1.49-2.56; P =.002), public insurance with supplement (aOR, 1.62; 95% CI, 1.24-2.11; P =.028), and new patient appointments (aOR, 0.38; 95% CI, 0.30-0.49; P <.001) were independent predictors for engaging in a telephone visit compared with videoconferencing.

Among several study limitations, home address zip code was used as a surrogate marker for patient income. Additionally, the study was limited to a single site in a state with near universal health insurance coverage.

“Health care stakeholders should ensure equal availability, coverage, and reimbursement across telehealth options to prevent disincentivizing certain modalities and potentially worsening health care disparities,” the researchers commented.


Rodriguez NJ, Okwara NC, Shen L, et al. Impact of telemedicine modalities on equitable access to ambulatory gastroenterology care. Gastroenterol. Published online May 26, 2021. doi: 10.1053/j.gastro.2021.05.042