Those who need wearables most don’t use them

  • November 7, 2022
  • Steve Rogerson

People who most need wearable health devices, such as smart watches and fitness bands, may use them the least, according to the American Heart Association (AHA).

Age, education and income are factors associated with less use of wearable health devices among people with and at risk of cardiovascular disease, according to preliminary research presented at the AHA’s Scientific Sessions in Chicago this week.

Wearable devices are electronic devices worn on or close to the body that monitor and track health or physical activity. Wearables may help manage cardiovascular health more effectively, with features such as physical activity monitoring, heart-rate tracking and heart electrical activity tracing.

“We may be able to use artificial intelligence with health information from wearable devices to help people reduce their risk of heart disease,” said study lead author Lovedeep Dhingra, a postdoctoral research fellow in the Cardiovascular Data Science (CarDS) Lab at the Yale School of Medicine in New Haven, Connecticut. “Given these benefits, it is crucial to understand who is using these devices. In our study, we evaluated how many adults with heart disease or at risk for heart disease used wearables. We also looked at whether wearables’ use was equitable among patients of different age groups, sex, education, income levels and diverse racial and ethnic groups.”

Dhingra and colleagues analysed the health information of 9303 adults in the USA who responded to the Health Information National Trends Survey (Hints) in 2019 and 2020. Focusing on participants with cardiovascular disease or who were at risk of cardiovascular disease, such as high blood pressure, type-two diabetes, smoking or obesity, researchers evaluated responses in the survey question that asked if they had used a wearable device to track their physical activity or health in the past year. Estimated wearable device use was cross-referenced by age, gender, race and ethnicity, education level and income, as well as participants’ willingness to share their wearable data with health care professionals.

“Even though the survey did not ask participants about specific types of wearable devices, examples of wearable devices were included to help respondents answer the question about whether or not they had used a wearable device in the previous 12 months,” Dhingra said. “The most common wearable devices included smart watches and fitness bands at the time of the survey, though the category continues to expand to include other devices.”

Researchers were able to use survey-weighted analyses to estimate nationwide numbers. Their analysis found that people at risk for cardiovascular disease were less likely to use wearable devices. Specifically, an estimated 3.6 million people with cardiovascular disease and 34.4 million people at risk of cardiovascular disease in the USA used wearables. That translates to only 18% of all people with cardiovascular disease, and 26% of all people at risk for cardiovascular disease.

In comparison, 29% of the total adult US population used wearable devices.

Only 12% of people with cardiovascular disease older than 65 years of age used wearable devices, even though it is estimated half of all people with cardiovascular disease are older than 65. In comparison, 17% of people with cardiovascular disease ages 50 to 64 years reported using wearables, and 33% of those in the 18 to 49-year age group with diagnosed cardiovascular disease used wearables.

While 22% of all people at risk of heart disease are 65 years or older, only 14% of elderly patients at risk of heart disease used wearable devices.

People with cardiovascular disease with an annual household income of $50,000 or more were four times more likely to use wearables than those with annual household incomes less than $20,000.

Education beyond a college degree was associated with 3.6-fold higher wearable use than those who received a lower education level.

More than 80% of people at risk for cardiovascular disease responded that they would be willing to share the health information collected by their wearable device to improve their health care. Differences in willingness to share health data across different demographic subgroups were minor – age group, sex, race and ethnicity, education level and household income.

“We were surprised to find that people with cardiovascular disease were notably less likely than people without cardiovascular disease to use wearable devices, which suggests those who are most likely to benefit from these technologies appear to be less likely to use them,” Dhingra said. “We need to ensure that wearable devices reach the people who need them most, by improving equitable access and promoting wearables as health devices to help improve health and decrease health disparities.”

Bethany Barone Gibbs, associate professor in the department of epidemiology and biostatistics at West Virginia University School of Public Health in Morgantown, West Virginia, added: “Wearables are effective tools to help improve cardiovascular health through enhanced self-monitoring. There is good evidence that when people utilise wearables, they may participate in more physical activities. In addition, the emerging ability of providing objective data to be used during patient-clinician interactions is very promising, since prescription of physical activity from a health care professional often increases follow-through. This study highlights important disparities in the use of wearables. These inequities in access and use, if addressed, are an opportunity to improve cardiovascular health particularly among people in high-risk groups or under-resourced communities.”

Co-authors were Arya Aminorroaya, Evangelos Oikonomou, Arash Aghajani Nargesi and Rohan Khera. The study was funded by the National Heart, Lung & Blood Institute, a division of the National Institutes of Health, and the Doris Duke Charitable Foundation.