---
type: source
title: "Telehealth use is 1.62-1.67x higher in low-deprivation areas vs high-deprivation areas — no evidence of telehealth improving access for highest-need populations (2016-2024)"
author: "Multiple authors, Johns Hopkins (PNAS Nexus, February 2025)"
url: https://academic.oup.com/pnasnexus/article/4/2/pgaf016/8003900
date: 2025-02-01
domain: health
secondary_domains: []
format: journal-article
status: null-result
priority: high
tags: [telehealth, mental-health, access-equity, deprivation, disparity, primary-care, psychiatry]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

**Full citation:** Multiple authors (Johns Hopkins). "Telehealth and area deprivation, 2016-2024." PNAS Nexus. February 2025.

**Study design:** EHR analysis, Johns Hopkins health system. 2016-2024. n=42,640 primary care patients; n=12,846 psychiatry patients.

**Key findings:**

1. **Primary care:** Patients from low-deprivation areas were **1.62x more likely** to use telehealth than patients from high-deprivation areas.

2. **Psychiatry (mental health):** Patients from low-deprivation areas were **1.67x more likely** to use telehealth than patients from high-deprivation areas.

3. **No evidence of improvement:** The study found "no evidence of telehealth improving access for high-deprivation area patients" — over the 2016-2024 period, the deprivation-related disparity in telehealth use did not narrow.

4. **Coverage of period:** This is a pre-pandemic, pandemic, and post-pandemic time series — the full arc of telehealth expansion. The expansion did not reduce deprivation-related disparities.

**Context:**
- Area Deprivation Index (ADI) used to measure neighborhood disadvantage
- Johns Hopkins health system = urban academic medical center with a high proportion of Medicaid and underserved patients — if telehealth were going to reach underserved populations anywhere, this system should be a favorable context
- The persistence of the disparity across the full 2016-2024 arc (including COVID-driven telehealth expansion) is the most damning finding

## Agent Notes

**Why this matters:** This is the strongest direct test of whether telehealth reduces socioeconomic disparities in access. It uses a long time series (8 years), large sample, and a validated deprivation index. The finding that LOW-deprivation patients are 62-67% more likely to use telehealth — and that this ratio did NOT improve even through the COVID telehealth expansion — is a clear disconfirmation of the "telehealth closes the access gap" hypothesis.

Combined with Jorem et al. 2026 (JAMA Net Open, mental health specialists seeing fewer new patients with high telemedicine), this creates a coherent multi-evidence picture: telehealth expands access for existing patients in low-deprivation areas while leaving high-deprivation patients behind.

**What surprised me:** The study spans 2016-2024 — before, during, and after COVID. The COVID telehealth surge was specifically designed to expand access during an emergency. The deprivation disparity persisted through it. This is the clearest evidence that structural barriers (not just awareness or provider hesitance) prevent telehealth from reaching underserved populations.

**What I expected but didn't find:** Narrowing of the disparity during COVID (when telehealth was maximally expanded and available). The null on narrowing is the finding.

**KB connections:**
- [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]] — this is the strongest available evidence for the "already-served" mechanism across a multi-year longitudinal study in both primary care AND psychiatry
- [[social isolation costs Medicare 7 billion annually and carries mortality risk equivalent to smoking 15 cigarettes per day making loneliness a clinical condition not a personal problem]] — high-deprivation populations (those most at risk for social isolation) are precisely the ones least reached by telehealth

**Extraction hints:**
- "Telehealth utilization is 1.62-1.67x higher in low-deprivation areas and the gap did not narrow across an 8-year period including COVID expansion, confirming that structural barriers prevent telehealth from closing the mental health access gap for the highest-need populations" — high confidence (large n, long time series, validated deprivation measure)
- This is the anchor evidence for the "serves the already-served" mental health telehealth claim

## Curator Notes

PRIMARY CONNECTION: [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]]

WHY ARCHIVED: 8-year longitudinal study (2016-2024) showing telehealth use 1.62-1.67x higher in low-deprivation areas with no convergence — the strongest direct disconfirmation of the "telehealth closes the access gap" hypothesis.

EXTRACTION HINT: This is the anchor evidence for the mental health telehealth access claim. Extract as the primary quantitative finding (1.62x primary care, 1.67x psychiatry) with the 8-year no-improvement arc as the key methodological strength.
