Flipping the Script: Low-Income Cancer Patients Lead in Telehealth Use

Abstract

While telehealth has rapidly expanded across the U.S. healthcare landscape, prevailing assumptions suggest that low-income populations face the most significant barriers to access. However, emerging evidence from national datasets challenges this assumption, indicating that some low-income populations, particularly cancer patients, engage in telehealth at higher rates than their higher-income counterparts. This study examines differences in telehealth utilization between low-income and higher-income U.S. adults with a history of cancer and explores the sociodemographic and structural factors associated with higher telehealth engagement among low-income patients. A quantitative, correlational analysis was conducted using pooled cross-sectional data from the National Health Interview Survey (NHIS), 2011 to 2023. The sample included adult cancer survivors stratified by household income relative to the federal poverty level. Logistic regression was used to evaluate the association between income and telehealth use, controlling for predisposing (age, gender, race/ethnicity), enabling (education, employment, insurance), and need-based (self-reported health status) variables. Low-income cancer patients were significantly more likely to use telehealth services compared to their higher-income counterparts (AOR 1.084; 95% CI 1.02–1.15; p<.01), even after adjusting for enabling factors. Among the low-income group, individuals employed in the past year and those with higher educational attainment had even greater odds of telehealth engagement. Women and middle-aged adults also reported higher utilization than men and older adults. Contrary to dominant narratives, these findings suggest that low-income cancer patients actively engage in virtual care when appropriate enabling conditions are present.