Associations of Demographic, Socioeconomic, and Cognitive Characteristics With Mobile Health Access: MESA (Multi-Ethnic Study of Atherosclerosis)

Abstract

Background Mobile health (mHealth) has an emerging role in the prevention of cardiovascular disease. This study evaluated possible inequities in mHealth access in older adults. Methods and Results mHealth access was assessed from 2019 to 2020 in MESA (Multi-Ethnic Study of Atherosclerosis) telephone surveys of 2796 participants aged 62 to 102 years. A multivariable logistic regression model adjusted for general health status assessed associations of mHealth access measures with relevant demographic, socioeconomic, and cognitive characteristics. There were lower odds of all access measures with older age (odds ratios [ORs], 0.37-0.59 per 10 years) and annual income <$50 000 (versus ≥$50 000 ORs, 0.55-0.62), and higher odds with higher Cognitive Abilities Screening Instrument Score (ORs, 1.22-1.29 per 5 points). Men (versus women) had higher odds of internet access (OR, 1.32 [95% CI,1.05-1.66]) and computing device ownership (OR, 1.31 [95% CI, 1.05-1.63]) but lower fitness tracker ownership odds (OR, 0.70 [95% CI, 0.49-0.89]). For internet access and computing device ownership, we saw lower odds for Hispanic participants (versus White participants OR, 0.61 [95% CI, 0.44-0.85]; OR, 0.69 [95% CI, 0.50-0.95]) and less than a high school education (versus bachelor's degree or higher OR, 0.27 [95% CI, 0.18-0.40]; OR, 0.32 [95% CI, 0.28-0.62]). For internet access, lower odds were seen for Black participants (versus White participants OR, 0.64 [95% CI, 0.47-0.86]) and other health insurance (versus health maintenance organization/private OR, 0.59 [95% CI, 0.47-0.74]). Chinese participants (versus White participants) had lower internet access odds (OR, 0.63 [95% CI, 0.44-0.91]) but higher computing device ownership odds (OR, 1.87 [95% CI, 1.28-2.77]). Conclusions Among older-age adults, mHealth access varied by major demographic, socioeconomic, and cognitive characteristics, suggesting a digital divide. Novel mHealth interventions should consider individual access barriers. Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT00005487.

Keywords: cardiovascular disease; mHealth; mobile health; prevention.

Figures

Figure 1. Flow diagram to select eligible cohort for analysis.

MESA indicates Multi‐Ethnic Study of Atherosclerosis; and mHealth, mobile health.

Figure 2. Timeline of all examinations and assessments.

The MESA (Multi‐Ethnic Study of Atherosclerosis) Examination 1 was the baseline examination for all participants, and Examinations 5 and 6 were 2 follow‐up examinations. All 3 examinations were administered in person at a MESA site, as was the Cognitive Abilities Screening Instrument assessment. MESA Follow‐Up 21, which included the mobile health (mHealth) survey, was administered by telephone.

Figure 3. Multivariable logistic regression model for association between mobile health outcomes and demographic, socioeconomic, and cognitive characteristics.

The model was adjusted for all exposure variables including age, sex, race and ethnicity, family income, education level, health insurance status, and Cognitive Abilities Screening Instrument (CASI) score, and a confounding variable, general health status. Computing device includes smartphone, laptop, desktop, and tablet. Fitness tracker includes Fitbit, Apple Watch, and similar devices. Odds ratios with 95% CIs are shown on a logarithmic scale. HMO indicates health maintenance organization.