Analysis Reveals Racial Disparities in Telemedicine Use During COVID-19 Pandemic Among Patients With Hematologic Malignancies

Data from a retrospective observational study revealed that White patients with hematologic malignancies in the United States had significantly higher uptake of telemedicine vs Black patients, reflecting disparities that require further exploration.¹

Results from the analysis, which were presented during the 2021 ASH Annual Meeting & Exposition, revealed an overall tradeoff for patients with hematologic malignancies, with a reduction in in-person visits and increased telemedicine uptake.

During the period of the pandemic featured in the study, which ranged from March 2020 to February 2021, disparate uptake of telemedicine among Black patients vs White patients was observed, and that proved to be true across all diseases and treatments combined (t = 9.5, P < .01), including acute myeloid leukemia (AML) inpatient treatments (t = 2.4, P = .04), multiple myeloma oral treatment (t = 6.0, P < .01), and in multiple myeloma inpatient treatments (t = 2.3, P = .04).

Throughout the pandemic period, no reductions in in-person visit rates for Black patients was observed across all diseases and treatment categories vs the projected rates. During the early pandemic months, ranging from March 2020 to May 2020, a statistically significant 18% reduction (95% CI PI, 9.9%-25%) in in-person visit rates was observed for White patients who were receiving oral medication. The actual visit rate was 1.61 visits per patient per month vs a projected visit rate of 2.0 visits per patient per month (95% CI PI, 1.8-2.2).

“These patterns in documented visits reflect potential telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors,” Natalia Neparidze, MD, lead study author and an associate professor of Internal Medicine and Hematology at Yale School of Medicine, said in a poster presentation on the data.

The onset of the COVID-19 pandemic impacted healthcare delivery by reducing the number of in-person visits and pushing telemedicine to the forefront of care. Differences in these trends across racial groups are not clear. The study presented during the meeting was conducted to further explore racial disparities in visit throughout the pandemic for those with documented active treatment for hematologic malignancies.

To do this, investigators leveraged data from the nationwide Flatiron Health electronic health record–derived deidentified database, which included information from approximately 280 cancer clinics and around 800 sites of care across the United States.

The analysis included patients with AML, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia, or multiple myeloma. Patients needed to be at least 18 years of age and documented receipt of at least 1 systemic therapy that they received between March 1, 2016, and February 28, 2021.

Treatment types within lines of therapy were stratified based on race (White vs Black/African American) and treatment type within lines of therapy (orals vs inpatient). Oral treatments include oral agents plus outpatient infusions with orals. Inpatient treatment could comprise chemotherapy, bone marrow transplant, and CAR T-cell therapy.

To estimate projected counterfactual monthly visit rates between March 2020 and February 2021, fit time-series forecasting models to pre-pandemic monthly visit rate data were leveraged. The differences between projected and actual visits were calculated by using cross-correlation analysis to assess for significant differences in visits between Black and White patient populations.

The analysis included a total of 24,432 patients; this included 2,343 Black patients and 16,218 White patients. Among patients receiving oral treatment in-person, 6.6% were Black and 32.0% were White; 0.9% and 4.7% of patients, respectively received oral treatment via telemedicine. Moreover, 4.8% and 46.0% of patients who received in-person inpatient treatment were Black and White, respectively; 0.5% and 4.7% of patients, respectively, received inpatient treatment via telemedicine.

Reference

1. Neparidze N, Lau KW, Wang X, et al. Racial disparities in telemedicine uptake during the COVID-19 pandemic among patients with hematologic malignancies in the United States. Blood. 2021;138(suppl 1):1973. doi:10.1182/blood-2021-153787