Digital Divide: Marked Disparities in Computer and Broadband Internet Use and Associated Health Inequalities in the United States

Background: Despite the considerable increase in computer and internet use over the past two decades, few studies have examined socioeconomic, demographic, and health characteristics associated with computer and internet use in the United States. Community-level differences in computer and internet use and associated disparities in health and mor tality indicators have not been analyzed. This study examines these associations at the individual and community level using national census, health, and mortality data. Methods: We analyzed data from the 2017 American Community Survey (ACS) Micro-data Sample, the 2013-2017 ACS Summary File, 2013-2017 National Vital Statistics System, and 2019 County Health Rankings and Roadmaps. Health and socioeconomic characteristics associated with broadband internet and computer use among adults aged ≥18 were modeled by logistic regression (N=2,385,595). Results: In 2017, 89.7% of Asian/Pacific Islanders (APIs) had broadband internet service, compared with 66.0% of American Indians/Alaska Natives (AIANs), 77.2% of Blacks/African-Americans, 78.8% of Hispanics, and 83.5% of non-Hispanic Whites. APIs (97.4%) were more likely than other racial/ethnic groups to own or use a computer (including smartphones), while AIANs (80.3%) were less likely. Socioeconomic gradients in internet and computer use were marked. Those below the poverty level and with less than a high school education reported 18 and 15 percentage points lower rates of internet and computer use respectively. Compared to metropolitan areas, nonmetropolitan areas had lower internet access (80.3% vs. 69.7%) and computer use (88.4% vs. 80.5%). Rural areas and small urban towns had the lowest level of internet and computer use. Risks of disabilities and lack of health insurance were greater among persons with lower broadband internet and computer access. Communities with low internet and computer use had seven years shorter life expectancy than communities with high use and were at increased risks of mortality from various chronic conditions, poor health, mental distress, hospitalization, smoking, obesity, and physical inactivity. Conclusions and Implications for Translation: Significant socioeconomic and racial/ethnic disparities in internet and computer use and associated health inequalities exist in the US. Closing the social divide in internet and computer use can positively impact individual empowerment, educational attainment, economic growth, community development, access to health care and health-related information, and health promotions efforts. Key words: • Digital divide • broadband internet • computer use • disability • health insurance • causespecific mortality • morbidity • health behaviors Copyright © 2020 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.