Assessing Access to Digital Services in Health Care–Underserved Communities in the United States: A Cross-Sectional Study

Objective: To evaluate the spatial association between the access to broadband and social and health care vulnerability in the United States at the county level. Patients and Methods: Data from 3108 counties in the contiguous United States was used in this study. Access to broadband was defined as the percentage of population with a high-speed internet subscription. County-level data for access was obtained from the Survey and American Community Survey Geographic Estimates of Internet Use, 1997-2018. Indexes for resource-constrained health system, health care access barriers, and social vulnerability were obtained from the 2021 Surgo COVID-19 Vaccine Uptake Index and the Centers for Diseases and Control. We used spatial bivariate and multivariate analyses to determine the geospatial association between broadband access and the health care and social determinants. After identifying the geospatial clusters, their rates for the health care and social indexes were compared using generalized linear mixed-effects models. Results: We found that the United States exhibits a distinct spatial structure with defined vulnerable communities characterized by a high social vulnerability index, a high health access barrier index, and a high resource-constrained health care system index. However, we found a negative geospatial association between these 3 indexes of vulnerability and the access to broadband. We identified a geographical cluster in the southern part of the country with low broadband access and poor social and health indicators. Conclusions: Most health care–underserved communities in the United States are located in digital deserts with low high-speed internet access. These digital barriers could prevent the successful expansion of digital health care services and might exacerbate health care disparities in these vulnerable communities.