Researchers said the findings raise concerns that the pandemic may be worsening existing disparities in overall health care use.

Using insurance claims from more than 6 million individuals with employer-based health insurance in 2019 and 2020, the researchers found the greatest increase in telehealth use among patients in counties with low poverty levels (about 48 visits per 10,000 people vs. 15 per 10,000 people in high-poverty areas) and in metropolitan areas (about 50 visits per 10,000 people vs. about 31 visits per 10,000 people in rural areas). While there was a 20-fold increase in the rate of telemedicine use when COVID-19 lockdowns began in March 2020, the study found that the rate of office-based medical encounters, which declined by nearly 50%, were not fully offset by the increase in telehealth visits.

"This study expands our understanding about the growing use of telehealth as the pandemic progresses," said Jonathan Cantor, lead author of the study and a policy researcher at the nonprofit research organization RAND, in a news release. "Given our findings, policymakers should consider increasing efforts to reach populations that are deferring in-office care and not replacing it with telehealth visits."

Study authors acknowledge some limitations of the study, including using data from a single employer-insured sample. “The results will not be generalizable to low-income individuals on Medicaid and older individuals on Medicare,” they wrote.

Past research has reported that prior to the pandemic, communities with poor geographic access to health care disproportionately used telehealth services.