September 17, 2021

Vulnerable populations sought virtual care during pandemic

Kaiser Permanente study shows Latinos and people with low incomes increased virtual visits more than other race, ethnicity, and income groups during the pandemic.

Contacts: Terry Kanakri

Heather Tremblay


New Kaiser Permanente research from Southern California published September 1, 2021, in Journal of Medical Internet Research showed that Latino or low-income patients had the largest percentage increase in use of telehealth during the COVID-19 pandemic.

Increases in telehealth visits during the COVID-19 pandemic varied across age, sex, race, ethnicity, and household income groups, while decreases in outpatient visits were similar across all subgroups except age groups. The rate of combined outpatient and telehealth visits in the Latino, Black, and low-income groups returned to pre-pandemic levels by October 2020.

“The use of virtual care during the pandemic shows us it is a potentially promising way to reduce health care disparities even after the pandemic ends,” said Lei Qian, PhD, a research scientist with the Kaiser Permanente Southern California Department of Research & Evaluation. “The study also showed that while seniors had the highest telehealth visit rate before and during the pandemic, they had the smallest percentage increase in telehealth visits during the pandemic among all age groups, suggesting that barriers may exist for many seniors.”

The study was conducted at Kaiser Permanente in Southern California, which serves more than 4.7 million racially, ethnically, and socioeconomically diverse members at its 15 hospitals and 234 medical offices. Researchers studied the period of January 5 to October 31, 2020, and the corresponding period in 2019 to determine the change in outpatient visits and telehealth visits. Weekly rates of outpatient and telehealth visits by age, sex, race, ethnicity, and neighborhood-level median household income were calculated and compared before and during the COVID-19 pandemic.

  • Across all subgroups, outpatient visit rates had a steep drop-off after the start of the pandemic, reaching their lowest levels by early April 2020, then gradually increasing, but remaining lower than pre-pandemic levels.
  • Across age groups, the outpatient visits decreased the least among patients 65 years and older (−29.6%) and the most among children ages 6 to 17 years (−50.2%).
  • Across all subgroups, telehealth visits increased sharply after the start of the pandemic.
  • Across age groups, the telehealth visits increased the most among children ages 0 to 5 years and the least among adults age 65 and older.
  • Telehealth visits increased more among males (293.9%) than females (260%) during the early pandemic.
  • Across racial and ethnic groups, Latino patients had the largest increase in telehealth visits across income levels with a 295.5% increase in telehealth visits, although their visit rates during the pre-pandemic and pandemic periods were lower than those of Black patients and white patients.
  • Across income levels, patients who were in the low-income group had the largest increase (313.5%) in telehealth visits.
  • The rate of combined outpatient and telehealth visits in the Latino, Black, and low-income groups returned to pre-pandemic levels by October 2020.

Qian said she sees the popularity of telehealth continuing beyond the pandemic.

“Given the growing familiarity with new telehealth technologies, even as the COVID-19 pandemic wanes, patients likely will continue to pursue telehealth services beyond pre-pandemic levels,” she said.

Other authors on this study from the Kaiser Permanente Southern California Department of Research & Evaluation are Lina S. Sy, MPH; Vennis Hong, MPH; Sungching Glenn, MS; Denison S. Ryan, MPH; Kerresa Morrissette, MPH; and Stanley Xu, PhD. Steven J. Jacobsen, MD, PhD, formerly of the Department of Research & Evaluation also is a co-author. 

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 12.5 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health.