Digital Inequalities in the Use of eHealth Services in European Public Health Care Systems: Systematic Review of Observational Studies

Digital transformation in European public health systems has not benefited all groups equally. This review highlights persistent social inequalities in the use of key digital health tools. While many included studies were of high quality, heterogeneity in study designs, populations, and outcomes, as well as risk of bias, limits causal inference and the direct translation of findings into policy and practice. The findings nonetheless reveal systematic patterns of exclusion that are highly relevant for policy. Emphasizing an intersectional approach and standardizing measures of digital access will be essential to develop effective, equity-focused policies that ensure inclusive digital health services for all.