The geographic digital divide among dementia caregivers in the U.S.: a cross-sectional study.

backgroundDigital health tools, particularly patient portals, can support caregiving, but there is limited understanding of how sociodemographic and geographic factors influence digital health engagement among U.S. caregivers, especially dementia caregivers. Dementia caregiving involves complex coordination, medication management, and frequent healthcare interactions. Therefore, access to online medical records is particularly valuable. Moreover, most previous research focuses on general digital health adoption or patient portal use among patients, not caregivers, particularly among dementia caregivers, and rarely considers geographic differences or the interaction effects between age and caregivers' self-rated health. Comparing dementia caregivers to those without is essential because dementia caregiving entails more extensive care, longer duration, behavioral challenges, and emotional strain. These factors may increase reliance on digital health tools like online medical records. However, national studies often do not distinguish between dementia and non-dementia caregiving in digital health analyses.

objectiveThis study explored how sociodemographic and geographic factors are associated with caregivers' frequency of accessing care recipients' online medical records, especially for caregivers of individuals living with dementia compared to those caregivers of individuals without dementia. We also evaluated the interaction effect between age and health condition, motivated by the hypothesis that digital engagement is influenced not only by age but also by functional health status.

methodsThis study examined caregivers' portal access frequency using data from the 2022 National Health Interview Survey, collected between March 7th and November 8th, 2022. Descriptive statistics captured differences in access frequency and sociodemographic characteristics between dementia caregivers and non-dementia caregivers. Three ordered logistic regression models examined predictors of accessing online medical records for dementia caregivers, non-dementia caregivers, and all caregivers, followed by an all-caregiver model with interaction terms to assess moderation effects between caregiver age and self-reported health. ArcGIS Pro was adopted to visually capture the geographic regional divide in portal access frequency across the U.S.

resultsOf the 6,252 total responses, 916 caregivers provided data on portal access frequency. More than half of dementia caregivers (60.25%) and non-dementia caregivers (51.11%) did not access online medical records in the past 12 months. Frequent access (≥ 10 times/year) was low across both groups (dementia caregivers (7.03%) vs. non-dementia caregivers (12.66%)). Survey-weighted ordered logistic regression models identified significant sociodemographic and geographic disparities in portal access frequency. Being female (OR = 1.931, SE: 0.074), having a bachelor's degree (OR = 1.769, SE: 0.168), and being married (OR = 1.749, SE: 0.068) were associated with higher portal access frequency in the all-caregivers model, and similar results were found in dementia caregivers and non-dementia caregivers. Regarding geographic disparities, dementia caregivers residing in micropolitan areas had substantially lower odds of frequent portal access than those in metropolitan areas (OR = 0.633, SE: 0.071); a similar trend was observed among dementia and non-dementia caregivers. Rural residence was also associated with lower portal access among dementia caregivers (OR = 0.529, SE: 0.152) and non-dementia caregivers (OR = 0.654, SE: 0.097). In the all-caregiver sample, caregivers in small-town areas (OR = 0.522, SE: 0.071) had lower odds of portal access compared to metropolitan caregivers. Health status showed differential patterns across caregiving groups. Among dementia caregivers, reporting very good health (vs. excellent) was associated with lower odds of portal access (OR = 0.268, SE: 0.023), whereas among non-dementia caregivers, very good health was associated with higher portal access (OR = 1.246, SE: 0.062). Good or fair health was associated with lower portal access across all caregiver groups. Interaction analysis revealed that as caregiver age increased, those in poor health had a significantly lower portal access frequency.

conclusionsAccessing online medical records among family caregivers remains limited and varies notably by gender, educational attainment, geographic location, and the interaction between age and health status. These findings highlight the importance of developing tailored digital support strategies that address the intersecting socioeconomic and health-related barriers faced by caregivers, particularly as artificial intelligence-enabled tools become more prevalent in dementia care. Older caregivers in poor health are especially unlikely to adopt digital resources, underscoring the urgent need for targeted outreach and educational initiatives. Additionally, the persistent geographic digital divide among dementia caregivers, especially those in small towns, calls for increased support to promote equitable access to caregiving technologies.

trial registrationThis study conducted a secondary data analysis, so trial registration is NOT required because it does not run a prospective randomized trial. And Institutional Review Board approval is also not needed because the dataset is de-identified and public.