J Am Med Inform Assoc doi:10.1136/jamia.2010.006015
  • Case report

Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access

  1. Dean Schillinger1,2
  1. 1Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
  2. 2Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
  4. 4School of Public Health & Community Health, University of Washington, Seattle, Washington, USA
  5. 5Center for Health and Community, University of California San Francisco, San Francisco, California, USA
  6. 6Kaiser Foundation Health Plan, Internet Services Group, Oakland, California, USA
  1. Correspondence to Dr Urmimala Sarkar, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, Box 1364, 1001 Potrero, Bldg 10, 3rd Floor, San Francisco, CA 94143-1364, USA; usarkar{at}
  • Received 14 May 2010
  • Accepted 17 December 2010
  • Published Online First 24 January 2011


The authors investigated use of the internet-based patient portal,, among a well-characterized population of adults with diabetes in Northern California. Among 14 102 diverse patients, 5671 (40%) requested a password for the patient portal. Of these, 4311 (76%) activated their accounts, and 3922 (69%), logged on to the patient portal one or more times; 2990 (53%) participants viewed laboratory results, 2132 (38%) requested medication refills, 2093 (37%) sent email messages, and 835 (15%) made medical appointments. After adjustment for age, gender, race/ethnicity, immigration status, educational attainment, and employment status, compared to non-Hispanic Caucasians, African–Americans and Latinos had higher odds of never logging on (OR 2.6 (2.3 to 2.9); OR 2.3 (1.9 to 2.6)), as did those without an educational degree (OR compared to college graduates, 2.3 (1.9 to 2.7)). Those most at risk for poor diabetes outcomes may fall further behind as health systems increasingly rely on the internet and limit current modes of access and communication.


  • Funding Funds were provided by National Institute of Diabetes, Digestive and Kidney Diseases R01 DK65664 and National Institute of Child Health and Human Development R01 HD046113. This work was also supported by the National Center for Research Resources (KL2 RR024130). US is supported by Agency for Healthcare Research and Quality K08 HS017594. DS is supported by a grant from Agency for Healthcare Research and Quality R18 HS01726101, an NIH Clinical and Translational Science Award ULRR024131.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the institutional review boards at Kaiser Foundation Research Institute and University of California San Francisco.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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