Differences in electronic personal health information tool use between rural and urban cancer patients in the United States: Secondary data analysis

Alexandra Greenberg-Worisek, Liaa Ferede, Joyce Balls-Berry, Ian Marigi, Emily Valentin Mendez, Numra Bajwa, Melody Ouk, Minerva Orellana, Felicity Enders

Research output: Contribution to journalArticlepeer-review


Background: Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. Objective: Few studies have explored whether there is a difference in cancer patients’ current use of health information technology tools by residential location. Methods: Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. Results: Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). Conclusions: The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions.

Original languageEnglish (US)
Article numbere17352
JournalJMIR Cancer
Issue number2
StatePublished - Jul 2020


  • Cancer
  • Digital divide
  • Disparities
  • Health research
  • Patient engagement

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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