This study examined disparities in telehealth utilization across various health care services among adults in California, with particular focus on racial, ethnic, and linguistic differences. While telehealth has emerged as a potential tool for addressing health care disparities, evidence suggests that utilization patterns may exacerbate existing inequities. Using the 2021-2022 California Health Interview Survey (CHIS) conducted in diverse languages, authors employed descriptive statistics and nonlinear Blinder-Oaxaca decomposition to analyze disparities in telehealth utilization. Authors stratified analyses by visit purpose: mental health, primary care, acute care, chronic care, orthopedics, dermatology, and ophthalmology.

Findings: Compared with non-Hispanic whites, African Americans used telehealth 4.1% more, whereas Hispanics/Latinos and Asians used it 5.9%  and 11.3% less, respectively. For Hispanics/Latinos, approximately 14% of the disparity remained unexplained by measured covariates, while for Asians, 92% was unexplained. Individuals with limited English proficiency (LEP) were 9.6% less likely to use telehealth overall, with 38% of this gap unexplained by measured factors. The disparity was most pronounced in mental health services, where LEP individuals utilized telehealth 4.9% points less than non-LEP individuals, with this gap entirely unexplained by sociodemographic factors. Subgroup analysis revealed telehealth utilization disparities between LEP and non-LEP individuals across all language groups, with LEP Spanish speakers using telehealth 4.3% points less than non-LEP Spanish speakers, LEP Asian language speakers using it 7.3% points less than non-LEP Asian language speakers, and LEP speakers of other languages using it 7.3% points less than their non-LEP counterparts.