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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1028 — Veteran's Access to Internet Varies by Race and Age: Potential Impact on VHA Electronic Health Communication Efforts

Gordon KS (REAP - West Haven VA/Yale University), Brandt CA (REAP - West Haven VA/Yale University), Goulet JL (REAP - West Haven VA/Yale University), Justice AC (REAP - West Haven VA/Yale University)

Objectives:
As health and health care communication is increasingly web-based in the VA, Internet and email access are critical for veterans in care. We estimated the proportion of veterans with Internet access and with an email address, and assessed whether access varied by veteran characteristics.

Methods:
We used follow-up 3 survey results from the Veterans’ Aging Cohort Study (VACS), a prospective multisite observational study of 4,122 veterans from October 2005 – January 2007. Outcomes of interest were having access to the Internet (yes, no) and having an email address (yes, no). Chi-square tests were used to compare proportions and logistic regression was used to assess multivariable associations.

Results:
Our sample participants were 98% male, 23% white, and 65% black, and mean age 53. 54% (2,208) had Internet access and 43% (1,728) had an email address. 68% of whites had Internet access compared to 50% of blacks (p = < 0.001), and 60% of whites said they had an email address compared to 37% of blacks (p = < 0.001). In adjusted logistic regression models, blacks compared to whites had 1/2 less odds of Internet access (OR 0.48 95% CI 0.40-0.58) and a 1/3 less odds of having an email address (OR 0.38 95% CI 0.32-0.46). The odds of having Internet and email lowered with each 10-year increment in age (OR 0.51 95% CI 0.46-0.56 and OR 0.49 95% CI 0.45-0.54 respectively). Among those who had access, whites access the Internet primarily at home (85%) and blacks at home (68%) and the library (14%). There was no significant difference in Internet access and email address by HIV status (p = 0.50, 0.82 respectively).

Implications:
There were inequities in Internet accessibility by age and race among veterans in our sample. Even after controlling for income and education we found twice as many whites had Internet access than blacks and 3 times more had an email address.

Impacts:
If the VA wishes to expand the use of electronic communication for patient services, such as ordering medication or my Health-e vet, we must address these inequities. Otherwise we will potentially underserve nearly 50% of veterans, and the disparity will be more pronounced for blacks and older patients.


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