Abstract Body: Background: Digital health programs can expand access to preventive care and potentially reduce inequities driven by social determinants of health. However, individuals with fewer financial resources may be less likely to participate, risking wider gaps. This study examined whether SES influences enrollment, engagement, and healthcare utilization in a cardiovascular digital health program.
Methods: We conducted a real world study of adults offered Hello Heart through their employer sponsored health benefits, comparing outcomes by SES proxied by area level median income. Lower income area residents (LARs) lived in tracts with median income below 138% of the federal poverty level (a Medicaid eligibility benchmark); others were classified as higher income area residents (HARs). We studied: (a) enrollment in the program, (b) engagement among enrolled users, measured as the number of blood pressure (BP) readings recorded within 6 months, and (c) healthcare utilization among participants with linked claims data, as compared to nonparticipants propensity matched on demographics and baseline health. Outcomes included primary care provider (PCP) visits and avoidable emergency department (ED) visits.
Results: Enrollment: Among 118,700 eligible adults, enrollment was modestly higher among LARs versus HARs. Adjusted logistic regression controlling for age, gender, and plan relationship showed LARs were 11% more likely to enroll (aOR = 1.11, p < 0.001). Engagement: Among 16,538 enrollees, there was no difference in the number of blood pressures taken during the first six months of enrollment between LARs and HARs, t = −0.30, p = 0.77). Utilization: Difference in differences estimates showed increased PCP visits (LAR: +412 per 1,000; HAR: +331 per 1,000) and reduced avoidable ED visits (LAR: −46 per 1,000; HAR: −48 per 1,000) for participants relative to matched nonparticipants. Adjusted models confirmed significantly greater PCP use and lower avoidable ED utilization among participants (ps < 0.05), with no significant interaction with area income (ps > 0.05).
Conclusions: In this large, real world evaluation, individuals from lower income communities enrolled in Hello Heart at slightly higher rates and engaged at levels comparable to those from higher income communities. Program participation was associated with increased PCP utilization and reduced avoidable ED use across income strata, suggesting potential to mitigate, rather than exacerbate, inequities linked to SES.