Geographic Disparities in Access to Broadband, Ambulance Services, and Health Care and Implications for Telehealth.

Importance: Telehealth has emerged as an effective way to facilitate access to health care, particularly in rural areas. The extent to which broadband services can sufficiently support the use of telehealth in rural areas with limited access to primary and acute care services is currently unknown. Objectives: To enumerate the extent to which rural residents in the US live in areas lacking broadband, ambulance services, and health care (hereafter referred to as broadband deserts [BBDs], ambulance deserts [ADs], and health care deserts [HCDs], respectively) and to estimate computer ownership and broadband subscription rates. Design, Setting, and Participants: This population-based cross-sectional study used AD and HCD data from September 2021 to February 2022, compiled from previous studies; broadband serviceable location data from the Federal Communications Commission 2024 Broadband Data Collection project; and the 2020 US Census Demographic and Housing Characteristics. Data were analyzed from November 2024 to July 2025. Main Outcomes and Measures: The number and percentage of people living in BBDs, ADs, and HCDs were estimated at national, regional, and state geographic levels and by rural residence. Populated census blocks were designated as BBDs if broadband speeds were slower than 100/20 megabits per second, as ADs if individuals lived more than a 25-minute drive from an ambulance station, and as HCDs if individuals lived more than a 30-minute drive from a health care facility. Results: The study included 41 states with a total population of 249.1 million. An estimated 11.9 million people (4.8%) resided in BBDs, with 10.5 million (88.1%) living in rural areas. Among rural residents, 946 278 individuals lived in an AD and HCD intersection with sufficient broadband available to support telehealth, and 649 225 individuals lived in a BBD, AD, and HCD intersection. A total of 95.0% of rural households had a computing device, and 88.5% had a broadband subscription, which was lower than the subscription rate among urban households (92.6%). Western states had the highest percentage of rural residents living in BBDs (31.9%); AD and HCD intersections with sufficient broadband to support telehealth (15.5%); and BBD, AD, and HCD intersections (6.7%). Conclusions and Relevance: This cross-sectional study found that 11.9 million people resided in BBDs, with 88.1% living in rural areas; rural households had lower broadband subscription rates than urban households. The findings suggest that broadband remains a critical determinant of health care access and that the potential of telehealth to mitigate gaps in primary, specialty, and emergency care is constrained by inadequate infrastructure and broadband subscription rates.