Inequalities in the use of digital health services among Finnish public sector employees 2017–2022

Abstract Background Lack of access and use of health services may widen health inequalities, but less is known about the impact of new digitally mediated health services. This study aims to analyse 1) trends in the adoption and use of digital health services across gender, age, and different socio-economic groups and 2) if the digital health services have substituted traditional services. Methods This register-based study included annually 32 000 full-time public sector employees of the City of Helsinki aged 20-59 years 2017-2022. Occupational position was used as an indicator of socio-economic position. Medically certified long-term sickness absence of more than 11 days was used to measure health. The use of digital health services per 100 person-years and the use of traditional health services were analysed using regression analysis. Results In 2017 the use of digital health services was very low but increased yearly until it peaked in 2020 during the Covid 19 -pandemic. Women used digital health services on average 46% more than men. Manual workers used digital health services less than professionals, and the difference was highest in 2019 (estimate -52.35 [95% CI -60.47--44.24] among women and -44.16 [95% CI -48.84--35.48] among men). The effect remained after adjusting for long-term sickness absence (estimate -50.02 [95% CI -58.09--41.96] among women and -44.58 [95% CI -51.28--37.84] among men). Adjusting for health status widened the difference among men from 2020 onwards. Conclusions The results show that socio-economic gradient in the adoption and use of new digital health services are steep and consistent. The difference was higher among men, after adjusting for health services need. New digital health services have partly replaced traditional services. The design of digital health services needs to make sure that lower socio-economic groups can better use these services according to their health needs. Also, traditional health services must remain an option. Key messages • Socio-economic inequalities in the adoption and use of new digital health services are steep. • The design of digital health services needs to make sure that lower socio-economic groups can better use these services according to their health needs.