Key result
Urban residence linked to greater telehealth use among kidney failure patients during the COVID-19 pandemic.
Why the study?
Telemedicine offers a potential solution to address disparities in health care access among rural and urban patients with kidney failure, prompting examination of utilization patterns before and during the COVID-19 pandemic.
Are there differences in telehealth utilization between rural and urban Medicare beneficiaries with kidney failure before and during the COVID-19 pandemic?
Cohort (n=787,959)
Yes
Are there differences in telehealth utilization between rural and urban Medicare beneficiaries with kidney failure before and during the COVID-19 pandemic?
p-value: p=< 0.01
Telehealth utilization increased significantly among Medicare beneficiaries with kidney failure during the COVID-19 pandemic, with higher uptake in urban areas but persistent racial, ethnic, and social disparities.
May indicate rural telehealth barriers in kidney failure; leaves open modality-specific equity strategies.
Rationale & Objective: Telemedicine offers a potential solution to address disparities in health care access among rural and urban patients with kidney failure. This study examined telehealth utilization patterns and urban-rural differences before and during the coronavirus disease 2019 (COVID-19) pandemic. Study Design: Retrospective observational cohort study. Setting & Population: Medicare beneficiaries (with both parts A and B) with kidney failure, on kidney replacement therapy of any modality (excluding transplant) from the United States Renal Data System, totaling 787,959 patients (2017-2021). Exposure: Urban versus rural residence, before (January 2020) and during (January 2021) the COVID-19 pandemic. Outcomes: Telehealth utilization, defined as any claim for telemedicine services, including mental health, primary care, nephrology, and other services. Analytical Approach: Multivariable logistic regression assessed predictors of telehealth use. Geographic variation was analyzed using county-level data. Results: < 0.01) compared with in-center hemodialysis. Minimal differences in service types were observed between rural and urban patients. Limitations: Exclusion of Medicare Advantage and private insurance data may limit generalizability. The study did not assess outcomes associated with telehealth use. Conclusions: Telehealth use considerably increased for patients with kidney failure during the pandemic, particularly in urban areas, but racial, ethnic, and social disparities persist. Efforts to promote equitable telehealth use and access are essential to advance health equity for patients with kidney failure.
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Adler et al. (2026) conducted a cohort in Kidney failure (n=787,959). Urban residence vs. Rural residence was evaluated on Telehealth utilization (any claim for telemedicine services) (p=< 0.01). Urban residence was associated with increased telehealth use among patients with kidney failure during the COVID-19 pandemic, with significant differences by dialysis modality (P<0.01).
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