Broadband Access and Health Outcomes in FCC Priority Counties: A Longitudinal Analysis

Background: The relationship between broadband access and health outcomes is an emerging field of interest within public health research. In an increasingly digital world, it is important to understand how to best allocate broadband resources to maximize health impact and decrease health disparities. This study specifically investigates how levels of broadband connectivity are associated with health metrics for conditions such as diabetes, obesity, and preventable hospitalizations in counties identified as ‘priority’ by the Federal Communications Commission (FCC) due to their low broadband access and high rates of chronic disease. Objective: To understand the longitudinal relationship between broadband access and health outcomes in priority counties, specifically focusing on diabetes, obesity, and preventable hospitalizations. Methods: This study analyzes data from 171 FCC priority counties from 2013-2020. Using regression models, we explore how broadband metrics, including broadband subscriptions and download speed, along with county characteristics such as rurality and persistent poverty, predict health outcomes. Health outcomes of interest include diabetes prevalence, obesity rates, and preventable hospitalizations. Results: A 1 percentage point increase in broadband subscriptions was associated with a 0.5% decrease in the odds of diabetes prevalence (odds ratio [OR] 0.995, 95% Confidence Interval [CI] 0.992-0.997). No significant relationship was found between broadband and obesity rates and preventable hospitalizations. County disparities were evident, with counties experiencing persistent poverty showing a 10% increase in the odds of diabetes prevalence (OR 1.100, 95% CI 1.062-1.140) and a 20.3% increase in preventable hospitalizations (β=1.203, 95% CI 1.131-1.280, P<.001). Rural counties were predicted to have a 17.6% increase in the odds of obesity prevalence (OR 1.176, 95% CI 1.127-1.228) and a 15.1% increase in the odds of diabetes prevalence (OR 1.151, 95% CI 1.111-1.191). Conclusions: Our data suggests that increased access to broadband may be correlated with decreased rates of diabetes in FCC priority counties. The study highlights the variable relationship between broadband access and health outcomes and predicts poorer health outcomes in rural, persistent poverty counties. This analysis provides a baseline for understanding the dynamics between broadband and health in critical need areas. Such insights highlight how expanding broadband infrastructure, especially in rural and impoverished regions where disease burden is high, may help reduce health disparities and improve healthcare service access. Future data can be incorporated to clarify causality and model how the adoption of broadband infrastructure may take time to facilitate telehealth usage and ultimately support improved health outcomes, and how these dynamics may differ depending on county characteristics.