Sociodemographic and Socioeconomic Determinants for the Usage of Digital Patient Portals in Hospitals: Systematic Review and Meta-Analysis on the Digital Divide

Abstract

Background: Digital patient portals (PPs) are platforms that enhance patient engagement and promote active involvement in health care by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by sociodemographic and socioeconomic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze sociodemographic and socioeconomic determinants affecting digital PP usage, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities.

Objective: This study aimed to conduct a meta-analysis of the sociodemographic and socioeconomic factors contributing to the digital divide in the usage of digital PPs.

Methods: A systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed, Web of Science Core Collection, and EBSCOhost. Screening involved 3 reviewers with consensus meetings to resolve discrepancies. Data on sociodemographic and socioeconomic factors and statistical outcomes were extracted, and study quality was assessed using the Mixed Methods Appraisal tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias.

Results: A total of 2225 studies were identified through a systematic review, and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (younger than 65 y) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 16% higher likelihood of using the digital PP than men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37% greater likelihood of using the digital PP in the meta-analysis. In addition, employed patients were 23% more likely to use the digital PP, while married patients had a 13% higher likelihood of using it than unmarried patients. Marital status and employment can be considered as measurable factors of social relationships.

Conclusions: The review confirms that sociodemographic and socioeconomic factors significantly influence the usage of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22% more likely to use digital PPs. Overall, sociodemographic factors, like marital status, primarily affect usage patterns, while socioeconomic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in health care.

Trial registration: German register of clinical trials DRKS00033125; https://drks.de/search/de/trial/DRKS00033125 and PROSPERO CRD42024567203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567203.

Keywords: digital divide; e-Health; hospital; meta-analysis; patient portal; sociodemographic; socioeconomic.

Figure 1

Own illustration according to Deursen and Helsper [19].

Figure 2

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.

Figure 3

Forest Plot “Gender” ([22-26,28,29,41-48]).

Figure 4

Forest plot “Education” ([23,24,26-29,41,42,44]).

Figure 5

Forest plot “Employment” ([22,23,25,29,44,48]).

Figure 6

Forest plot “Marital Status” ([23,25,27,29,48]).

Figure 7

Own illustration according to van Deursen and Helsper [19].