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. 2023 Mar 1;6(3):e235681.
doi: 10.1001/jamanetworkopen.2023.5681.

Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children

Ethan H Kim  1 , Jessica L Jenness  2 , Adam Bryant Miller  3   4 , Ramzi Halabi  1 , Massimiliano de Zambotti  5 , Kara S Bagot  6 , Fiona C Baker  5 , Abhishek Pratap  1   7   8   9   10
Affiliations

Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children

Ethan H Kim et al. JAMA Netw Open. .

Abstract

Importance: The use of consumer-grade wearable devices for collecting data for biomedical research may be associated with social determinants of health (SDoHs) linked to people's understanding of and willingness to join and remain engaged in remote health studies.

Objective: To examine whether demographic and socioeconomic indicators are associated with willingness to join a wearable device study and adherence to wearable data collection in children.

Design, setting, and participants: This cohort study used wearable device usage data collected from 10 414 participants (aged 11-13 years) at the year-2 follow-up (2018-2020) of the ongoing Adolescent Brain and Cognitive Development (ABCD) Study, performed at 21 sites across the United States. Data were analyzed from November 2021 to July 2022.

Main outcomes and measures: The 2 primary outcomes were (1) participant retention in the wearable device substudy and (2) total device wear time during the 21-day observation period. Associations between the primary end points and sociodemographic and economic indicators were examined.

Results: The mean (SD) age of the 10 414 participants was 12.00 (0.72) years, with 5444 (52.3%) male participants. Overall, 1424 participants (13.7%) were Black; 2048 (19.7%), Hispanic; and 5615 (53.9%) White. Substantial differences were observed between the cohort that participated and shared wearable device data (wearable device cohort [WDC]; 7424 participants [71.3%]) compared with those who did not participate or share data (no wearable device cohort [NWDC]; 2900 participants [28.7%]). Black children were significantly underrepresented (-59%) in the WDC (847 [11.4%]) compared with the NWDC (577 [19.3%]; P < .001). In contrast, White children were overrepresented (+132%) in the WDC (4301 [57.9%]) vs the NWDC (1314 [43.9%]; P < .001). Children from low-income households (<$24 999) were significantly underrepresented in WDC (638 [8.6%]) compared with NWDC (492 [16.5%]; P < .001). Overall, Black children were retained for a substantially shorter duration (16 days; 95% CI, 14-17 days) compared with White children (21 days; 95% CI, 21-21 days; P < .001) in the wearable device substudy. In addition, total device wear time during the observation was notably different between Black vs White children (β = -43.00 hours; 95% CI, -55.11 to -30.88 hours; P < .001).

Conclusions and relevance: In this cohort study, large-scale wearable device data collected from children showed considerable differences between White and Black children in terms of enrollment and daily wear time. While wearable devices provide an opportunity for real-time, high-frequency contextual monitoring of individuals' health, future studies should account for and address considerable representational bias in wearable data collection associated with demographic and SDoH factors.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr de Zambotti reported receiving grants from Verily Life Science and Noctrix Health as well as serving as chief scientific officer for and owning shares in Lisa Health outside the submitted work. Dr Bagot reported being cochair of Justice, Equity, Diversity, and Inclusion Advisory Council for the Adolescent Brain and Cognitive Development (ABCD) Study outside the submitted work. Dr Baker reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving research funding from Verily for an unrelated research study to assess the performance of devices in detecting sleep. Dr Pratap reported receiving grants from the Krembil Foundation and CAMH Discovery Fund during the conduct of the study and being employed by Biogen outside the submitted work; however, all analyses, writing, and initial submission were completed before Dr Pratap joined Biogen. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Wearable Device Data Availability From the Overall Adolescent Brain and Cognitive Development (ABCD) Study Cohort
Figure 2.
Figure 2.. Kaplan-Meier Curves of Participant Retention Based on Device Wear in the 21-Day Observation Period, by Sociodemographic and Socioeconomic Factors
Kaplan-Meier curves showed significant variation in participant retention based on device wear in the 21-day observation period by (A) participants’ race, (B) household income, and (C) parental education (based on International Standard Classification of Education [ISCED] levels). AIAN/P indicates American Indian, Alaska Native, and Pacific Islander.
Figure 3.
Figure 3.. Bar Plots of Total Wear Time by Sociodemographic and Study-Related Factors
Total wear time was by (A) race and ethnicity, (B) Adolescent Brain and Cognitive Development Study site location, and (C) participant enrollment period. C, Shading indicates months affected by the COVID-19 pandemic, with the dotted blue and orange lines showing the median wear time during and before the pandemic. CUB indicates University of Colorado Boulder; FIU, Florida International University; LIBR, Laureate Institute for Brain Research; MUSC, Medical University of South Carolina; OHSU, Oregon Health & Science University; Q, quarter; ROC, University of Rochester; SRI, SRI International; UCLA, University of California, Los Angeles; UFL, University of Florida; UMB, University of Maryland at Baltimore; UMICH, University of Michigan; UMN, University of Minnesota; UPMC, University of Pittsburgh; UTAH, University of Utah; UVM, University of Vermont; UWM, University of Wisconsin-Milwaukee; VCU, Virginia Commonwealth University; WUSTL, Washington University in St Louis; and YALE, Yale University.
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