Use of digital health services among patients with hypertension: a cross-sectional analysis of 1,751 insured adults in northeastern Germany

Abstract

Digital health services may support hypertension self-management. However, their utilisation in routine care remains inconsistent, and age-related differences may limit implementation, particularly in older patients with high comorbidity burden. To quantify age-related disparities in the utilisation of digital health services among patients with hypertension and to identify independent determinants of digital engagement in routine care. In this cross-sectional study, survey data were linked with insurance claims data from 2022 to 2023 for adults with documented hypertension in northeastern Germany. Participants were recruited via stratified sampling by age (18-49 vs. ≥50 years), gender and residential type. Utilisation and interest were assessed across 11 digital health services. Digital health literacy was measured using the eHealth Literacy Scale (eHEALS) and a comorbidity burden was derived from ICD-10 claims data. Multivariable logistic regression models adjusted for sociodemographic, infrastructural, and clinical covariates. A total of 1,751 participants were included (mean age 63 years). Significant age-related disparities were observed across all services. Younger participants showed substantially higher utilisation of online health information (64% vs 23%), health apps (57% vs 12%), wearables (42% vs 10%), and insurance portals (50% vs 15%; all p<0.001). Among younger individuals, interest exceeded current use, particularly for online appointment booking (72% vs 40%), wearables (68% vs 42%), and electronic health records (67% vs 13%). In contrast, interest among older participants remained low across services (8–30%), and 47% reported no home internet access (vs 3% of younger participants). Adequate digital health literacy was present in 69% of younger participants versus 26% of older participants (p<0.001). In multivariable analyses, younger age was independently associated with higher use of 9 of 11 services. Adequate digital health literacy was the strongest predictor and independently associated with higher use for 9 services. Reliable internet connectivity independently predicted the use of various digital health services. Substantial age-related disparities in digital health utilisation persist among patients with hypertension, even after adjustment for clinical and sociodemographic factors. The gap between interest and actual use in younger patients and the limited digital access and literacy among older patients indicate structural and educational barriers rather than a lack of motivation. Targeting digital health literacy and internet access may be crucial to ensure equitable implementation of digital cardiovascular care.