There’s a disconnect between health tech and the people it’s supposed to help

There’s no shortage of apps and wearables that aim to help people improve heart health. However, a pair of recent Yale studies find that those with the highest risk of heart disease are less likely to use this type of technology — even as tech companies add more heart health features to their devices.

“In these paired studies, we found that individuals at highest cardiovascular risk were least likely to use wearable devices, such as smartwatches, or use technology on their phones to track and improve their health,” Rohan Kera, a senior author on the study and assistant professor of medicine and at Yale School of Medicine, said in a statement.

Published in the Journal of American College of Cardiology: Advances, one study on health apps examined data from the National Cancer Institute’s Health Informational National Trends Survey (HINTS) between 2017 and 2020. Specifically, the researchers looked to see whether the participants had ever used a phone or tablet to track goals like losing weight, increasing physical activity, or quitting smoking.

The study found that roughly two out of five US adults with or at risk of heart disease use health monitoring apps. However, while older individuals and men were most at risk of developing cardiovascular disease, they were also less likely to use technology to improve their health. Households with lower levels of education and income were also found to be less likely to use this tech. Conversely, younger people, women, and Black individuals with higher education levels or household incomes were more likely to use health apps for this purpose.

These findings mirror those from the researchers’ earlier study which found that less than a quarter of US adults with cardiovascular disease use wearable devices. It also found that older people and those with lower education and income levels were less likely to use wearables. The researchers discovered that although roughly one-third of US adults used these devices, that number dropped to 18 percent among those with heart disease.

The results may seem counterintuitive if you’re a tech-savvy person who’s watched this category expand in recent years. Especially since tech companies have increasingly marketed smartwatches as life-saving tech and added advanced features to address heart disease. Case in point, the Apple Watch added FDA-cleared EKG capabilities in 2018 to help detect atrial fibrillation. It’s snowballed from there, with Samsung and Fitbit following suit on their smartwatches in 2020 and Garmin adding its own EKG feature this year. Moreover, Apple, Samsung, and Fitbit have all added passive aFib monitoring to their devices within the last year. Most major flagship smartwatches also now track blood oxygen levels and allow users to export their data into PDFs so they can be shared with doctors.

However, despite this push, both studies corroborate earlier research on health tech adoption. In 2020, Pew Research found that although 21 percent of Americans used a smartwatch or fitness tracker, the number rose to 31 percent in households earning at least $75,000 a year. It fell to 12 percent among households earning less than $30,000 annually. In that survey, women and college graduates were also more likely to regularly use the devices. Meanwhile, a 2021 meta-analysis found that across the board, health apps and wearables improved health for the rich and were ineffective for people with lower socioeconomic status.

Time and time again, researchers (including the authors of these studies) have identified lower tech literacy among older people, as well as the relatively high price of smartwatches as barriers to health tech adoption. Even so, tech companies continue to pursue more ambitious health applications, like noninvasive blood glucose tracking, cuffless blood pressure monitoring, and remote patient monitoring. The big question is whether any of it matters if the people who would most benefit are unlikely to use them.