Title : Should internet speed be a marker of social vulnerability? Insights from patients with ATTR cardiac amyloidosis
Abstract:
Background: Socioeconomic disparities influence access to medical care and cardiovascular disease outcomes. While there is an increasing interest in internet-based tools to improve patient care, access to high-speed internet and its association with outcomes is poorly understood.
Methods: We utilized the National Neighbourhood Data Archive (NaNDA) to assess average internet upload and download speeds by zip code for 208 patients with known systemic transthyretin amyloidosis with cardiomyopathy (ATTR-CM). Patient level zip code was used to identify social vulnerability index (SVI) and internet speed. Internet speed was classified as above or below the cohort median. Logistic regression and log-rank tests were performed to assess associations between internet speed, SVI, age, race, ejection fraction (EF) on presentation, and mortality.
Results: Data from 208 patients with known ATTR-CM (mean 80 years; 79% men; 39% Black) were evaluated. Residence in a zip code with faster upload (OR=0.428, 95% CI 0.333-0.551) and download (OR=0.428, 95% CI 0.333-0.551) internet speed was associated with reduced odds of death. This associated remained significant after controlling for SVI, reduced EF on presentation, Black race, and age for both upload (OR=0.322, 95% CI 0.141-0.738) and download (OR=0.333, 95% CI 0.149-0.747) speed. There were also significant differences in survival time among patients who belonged to zip codes with faster upload and download speeds (Figure 1).
Conclusion: Slow internet speed was associated with decreased survival among patients with ATTRCM. We highlight that access to high speed internet, which is not routinely assessed, may be a marker of social vulnerability.
