Determinants of Telehealth Use in the United States: A Decomposition Analysis of the HINTS 2022 (Preprint)

UNSTRUCTURED Using 2022 Health Information National Trends Survey (HINTS; N=6,252) data, we estimated survey-weighted probability models of any phone or video visit in the prior year and apportioned the model's explanatory power with a Shorrocks-Shapley decomposition. Thirty-nine percent of adults used telehealth in~2022. Geography was the largest contributor to explained variation (20.1%): adults in the West North Central and East South Central divisions were significantly less likely to use telehealth than peers in the Northeast. Health literacy (14.3%) and health status/needs (11.3%) outranked traditional socioeconomic indicators (6.3%) and demographic traits (8.2%). Disability was strongly and negatively associated with use, suggesting design barriers. Telehealth uptake hinges more on where people live and their capacity to navigate digital care than on income or education alone. Policies that pair broadband investments with region-specific service integration and digital health literacy programs and that mandate platforms accessible to people with disabilities are needed to narrow the persistent digital divide in the U.S.