Digital Divide Among Medicare Beneficiaries and the Diabetes Prevention Program

Abstract

Introduction: Successful delivery of the virtual Medicare Diabetes Prevention Program (MDPP) is influenced by a beneficiary's access to a computer and use of the Internet.

Methods: Using the 2020 nationally representative Medicare Current Beneficiary Survey Public Use File, a three-level categorical dependent variable was created: (1) has a computer AND uses Internet, (2) has a computer OR uses Internet, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was performed in 2023 to examine associations between socio-demographics, comorbidities, and computer access and Internet use.

Results: Of study beneficiaries aged ≥65 years with BMI≥25 kg/m² and no history of diabetes (n=3,875), 70.8% had a computer AND used Internet; 14.3% had a computer OR used Internet; and 14.9% had no computer AND did not use Internet. Hispanics and non-Hispanic Blacks (OR=0.28, 95% CI [0.17-0.43]) were less likely than non-Hispanic Whites to have a computer AND use Internet. Beneficiaries with less education (<high school) were less likely to have a computer AND use Internet (OR=0.04, [0.03-0.06]) or have a computer OR use Internet (OR=0.21, [0.14-0.33]) than those with more than a high school education. Beneficiaries with lower incomes (<$25,000) were less likely to have a computer AND use Internet (OR=0.27, [0.20-0.35]) or have a computer OR use Internet (OR=0.58, [0.41-0.80]) than those with higher incomes (≥$25,000).

Conclusions: Approximately 30% of potentially MDPP-eligible beneficiaries (representing ∼6 million beneficiaries) lacked full digital access. Efforts to encourage enrollment in the virtual MDPP must address digital disparities for beneficiaries at-risk for type 2 diabetes.