Midwest rural-urban disparities in use of patient online services for COVID-19

Ming Huang, Andrew Wen, Huan He, Liwei Wang, Sijia Liu, Yanshan Wang, Nansu Zong, Yue Yu, Julie E. Prigge, Brian A. Costello, Nilay D. Shah, Henry H. Ting, Chyke Doubeni, Jung Wei Fan, Hongfang Liu, Christi A. Patten

Research output: Contribution to journalArticlepeer-review


Purpose: Rural populations are disproportionately affected by the COVID-19 pandemic. We characterized urban-rural disparities in patient portal messaging utilization for COVID-19, and, of those who used the portal during its early stage in the Midwest. Methods: We collected over 1 million portal messages generated by midwestern Mayo Clinic patients from February to August 2020. We analyzed patient-generated messages (PGMs) on COVID-19 by urban-rural locality and incorporated patients’ sociodemographic factors into the analysis. Findings: The urban-rural ratio of portal users, message senders, and COVID-19 message senders was 1.18, 1.31, and 1.79, indicating greater use among urban patients. The urban-rural ratio (1.69) of PGMs on COVID-19 was higher than that (1.43) of general PGMs. The urban-rural ratios of messaging were 1.72-1.85 for COVID-19-related care and 1.43-1.66 for other health care issues on COVID-19. Compared with urban patients, rural patients sent fewer messages for COVID-19 diagnosis and treatment but more messages for other reasons related to COVID-19-related health care (eg, isolation and anxiety). The frequent senders of COVID-19-related messages among rural patients were 40+ years old, women, married, and White. Conclusions: In this Midwest health system, rural patients were less likely to use patient online services during a pandemic and their reasons for its use differ from urban patients. Results suggest opportunities for increasing equity in rural patient engagement in patient portals (in particular, minority populations) for COVID-19. Public health intervention strategies could target reasons why rural patients might seek health care in a pandemic, such as social isolation and anxiety.

Original languageEnglish (US)
JournalJournal of Rural Health
StatePublished - Sep 1 2022


  • COVID-19
  • health care delivery
  • patient portals
  • portal messaging
  • rural health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Midwest rural-urban disparities in use of patient online services for COVID-19'. Together they form a unique fingerprint.

Cite this