A 2006 report remarked on the lack of data about how use of many consumer health tools varies by subpopulation—a finding that one of the experts confirmed still rings true today. Also, due to the low overall levels of use of some of these resources it is hard to identify distinctive patterns by demographic group. As one expert explained, for many of these applications, the existing nationally representative data sets are often not sensitive enough to identify distinctions by demographic group and developing a sample large enough to do so would be cost prohibitive. Some of the data that do exist mirror the findings above about seeking health information.
Research and purchase prescription drugs
Several groups of individuals have been identified as having a higher propensity for looking online for information about prescription medications, including those with high-speed internet connections, who have been online for six or more years, who have a college degree, and who are part of the Baby Boom generation. Additionally, internet users who have either chronic conditions or disabilities are much more likely to seek drug information online (51%) than those without (35%).
Prevalence rates for purchasing medicines or vitamins online are low for all groups of internet users (around 13%), but patterns seem generally consistent with other types of online health use, with internet users who are female, between the ages 50-64, nonHispanic whites, and college graduates having slightly higher rates of buying medicines or drugs online than internet users in other demographic groups.
Communicate with relatives, friends, and other patients
Little research is available about how online communication with nonmedical professionals varies by demographic group. The HINTS project does report on variations of use of online support services, however, although some patterns are revealed—more females, 35-39-year-olds, and college graduates have used these services—the overall rate of use (3.9%) is so low, it may not be appropriate to place too much weight in these variations by subpopulation. The impact of these resources may vary by subpopulation. For example, one study on a website that provides social support services as well as information for women with breast cancer, suggests that it may be particularly effective for lower income or uninsured women.
Interact with the health care system
Communicating with a doctor or doctor’s office—another activity that is relatively rare among internet users—follows subpopulation patterns similar to searching online for health information. However, in a regression analysis that took into account a range of demographic factors, many of those relationships, including those for socioeconomic status and race, are not significant. One study that looked at data from both 2003 and 2005 noted that some of the factors that had in the earlier round predicted greater likelihood of online communications—such as higher education level and living in a metropolitan area—did not appear as significant factors in the later round. Consistent with the evidence on information seeking, having a health condition, being a cancer survivor and being female are significantly associated with communicating online with providers. The evidence on age is not consistent across studies.
As for learning about the health care system, one study notes that the tendency to go online for information about providers also follows the same bell-shaped pattern for age that peeks when individuals are between age 30 and 64.
Use a personal health record or multi-function portal
Much of the data about which subpopulations are using PHR-type applications come from provider groups. Several studies found that patients with commercial insurance were more likely to enroll in provider portals than those who were on Medicare or Medicaid. Some evidence suggests that white patients are more likely to enroll than other patients. The evidence on the relationship between health need and portal use is mixed. One multivariate regression analysis concluded that individuals who did not enroll in a patient portal were more likely to be on more prescription medications and have more medical conditions. On the other hand, analysis of a different patient portal found that individuals who were expected to have greater clinical need were more likely to sign on to the patient portal. A survey assessing interest (rather than use) of PHRs found that those with chronic conditions or their caretakers found the prospect of a PHR most compelling. One expert described the appeal that a PHR might offer an individual with a complex chronic condition like lupus who might be able to exchange her binder full of medical notes and records for one coherent, organized online record.
Studies also present conflicting findings about whether older or younger adults are more likely to enroll in patient portals. What is clear is that individuals across the age spectrum have signed up for patient portals. In one provider group, one-third of patients in their sixties and one-quarter of those patients in their seventies had enrolled in the PHR. In another portal, even though the median age at enrollment was 45, about 580 patients had signed up when they were in their 80s.