Hundreds of thousands in US Reside In Locations The place Docs Don’t Follow and Telehealth Doesn’t Attain

By Sarah Jane Tribble and Holly Ok. Hacker Knowledge visualizations by Lydia Zuraw

BOLIGEE, Ala. — Inexperienced lights flickered on the wi-fi router in Barbara Williams’ kitchen. Only one bar lit up — a weak sign connecting her to the world past her dwelling within the Alabama Black Belt.

In the event you repeatedly expertise connection points, click on right here to learn a model of this story designed to open quicker in low-signal areas.

Subsequent to the router sat medicines, vitamin D drugs, and Williams’ blood glucose monitor package.

“I haven’t used that thing in a month or so,” mentioned Williams, 72, waving towards the package. Identified with diabetes greater than six years in the past, she has developed nerve ache from neuropathy in each legs.

Williams is considered one of almost 3 million Individuals who dwell in largely rural counties that lack each well being care and dependable high-speed web, in line with an evaluation by KFF Well being Information, which confirmed that these folks are likely to dwell sicker and die youthful than others in America.

In contrast with these in different areas, sufferers throughout the agricultural South, Appalachia, and distant West are most frequently unable to make a video name to their physician or log into their affected person portals. Each are important methods to take part within the U.S. medical system. And Williams is amongst those that can do neither.

This yr, greater than $42 billion allotted within the 2021 Infrastructure Funding and Jobs Act is anticipated to start flowing to states as a part of a nationwide “Internet for All” initiative launched by the Biden administration. However this system faces uncertainty after Commerce Division Secretary Howard Lutnick final week introduced a “rigorous review” asserting that the earlier administration’s method was filled with “woke mandates.”

Excessive charges of persistent sickness and historic inequities are hallmarks of lots of the greater than 200 U.S. counties with poor companies that KFF Well being Information recognized. Dozens of medical doctors, teachers, and advocates interviewed for this text unanimously agreed that restricted web service hinders medical care and entry.

With out quick, dependable broadband, “all we’re going to do is widen health care disparities within telemedicine,” mentioned Rashmi Mullur, an endocrinologist and chief of telehealth at VA Larger Los Angeles. Sufferers with diabetes who additionally use telemedicine usually tend to get care and management their blood sugar, Mullur discovered.

Diabetes requires fixed administration. Left untreated, uncontrolled blood sugar may cause blindness, kidney failure, nerve harm, and ultimately loss of life.

Williams, who sees a nurse practitioner on the county hospital within the subsequent city, mentioned she is just not occupied with utilizing distant affected person monitoring or video calls.

“I know how my sugar affects me,” Williams mentioned. “I get a headache if it’s too high.” She will get weaker when it’s down, she mentioned, and all the time carries snacks like crackers or peppermints.

Williams mentioned she might even drink a soda pop — orange, grape — when her sugar is low however wouldn’t drink one when she felt it was excessive as a result of she would get “kind of goozie-woozy.”

‘This Is America’

Connectivity useless zones persist in American life regardless of no less than $115 billion lawmakers have thrown towards fixing the inequities. Federal broadband efforts are fragmented and overlapping, with greater than 133 funding applications administered by 15 businesses, in line with a 2023 federal report.

“This is America. It’s not supposed to be this way,” mentioned Karthik Ganesh, chief government of Tampa, Florida-based OnMed, a telehealth firm that in September put in a walk-in sales space on the Boligee Group Middle about 10 minutes from Williams’ dwelling. Residents can name up free life-size video consultations with an OnMed well being care supplier and use gear to test their weight and blood stress.

OnMed, which partnered with native universities and the Alabama Cooperative Extension System, depends on SpaceX’s Starlink to supply a high-speed connection in lieu of different choices.

A brief drive from the neighborhood middle, past Boligee’s Predominant Avenue with its abandoned buildings and an empty railroad depot and down a protracted gravel drive, is the 22-acre property the place Williams lives.

Final fall, Williams washed a dish in her kitchen, with its unforgiving linoleum-topped concrete flooring. A couple of months earlier, she mentioned, a person on the neighborhood middle signed her up for “diabetic shoes” to assist along with her sore toes. They by no means arrived.

As Williams spoke, steam rose from a pot of boiling potatoes on the range. One other pan sizzled with hamburger steak. And on a again burner simmered a mixture of Velveeta cheese, diced tomatoes, and peppers.

She spent years on her toes as head cook dinner at a diner in Cleveland, Ohio. The oldest of 9, Williams returned to her household dwelling in Greene County greater than 20 years in the past to look after her mom and a sister, who each died from most cancers within the again bed room the place she now sleeps.

Williams appeared out a window and recalled when the panorama was lined in cotton that she as soon as helped choose. Now three homes stand in a rigorously tended clearing surrounded by tall bushes. One belongs to a brother and the opposite to a sister who drives along with her every day to the neighborhood middle for train, prayers, and friendship with different seniors.

All of the surviving siblings, Williams mentioned, have diabetes. “I don’t know how we became diabetic,” she mentioned. Neither of their mother and father had been recognized with the sickness.

In Greene County, an estimated quarter of adults have diabetes — twice the nationwide common. The county, which has about 7,600 residents, additionally has among the many nation’s highest charges for a number of persistent ailments akin to hypertension, stroke, and weight problems, Facilities for Illness Management and Prevention information exhibits.

The county’s inhabitants is predominately Black. The federal CDC reviews that Black Individuals usually tend to be recognized with diabetes and are 40% extra doubtless than their white counterparts to die from the situation. And within the South, rural Black residents usually tend to lack dwelling web entry, in line with the Joint Middle for Political and Financial Research, a Washington-based assume tank.

To determine counties most missing in dependable broadband and well being care suppliers, KFF Well being Information used information from the Federal Communications Fee and George Washington College’s Mullan Institute for Well being Workforce Fairness. Reporters additionally analyzed U.S. Census Bureau, CDC, and different information to grasp the well being standing and demographics of these counties.

The evaluation confirms that web and care gaps are “hitting areas of extreme poverty and high social vulnerability,” mentioned Clese Erikson, deputy director of the well being workforce analysis middle on the Mullan Institute.

Digital Haves vs. Have-Nots

Simply over half of houses in Greene County have entry to dependable high-speed web — among the many lowest charges within the nation. Greene County additionally has among the nation’s poorest residents, with a median family revenue of about $31,500. Common life expectancy is lower than 72 years, beneath the nationwide common.

In contrast, the KFF Well being Information evaluation discovered that counties with the best charges of web entry and well being care suppliers correlated with greater life expectancy, much less persistent illness, and key way of life components akin to greater incomes and training ranges.

A type of is Howard County, Maryland, between Baltimore and Washington, D.C., the place almost all houses can hook up with quick, dependable web. The median family revenue is about $147,000 and common life expectancy is greater than 82 years — a decade longer than in Greene County. A a lot smaller share of residents dwell with persistent situations akin to diabetes.

One is 78-year-old Sam Wilderson, a retired electrical engineer who has managed his Sort 2 diabetes for greater than a decade. He has fiber-optic web at his dwelling, which is a number of miles from a restaurant he dines at each week after Bible examine. On a current day, the cafe had a visitor Wi-Fi obtain pace of 104 megabits per second and a 148 Mbps add pace. The speeds are quick sufficient for distant staff to reliably take video calls.

Individuals are demanding extra pace than ever earlier than. Most households have a number of gadgets — televisions, computer systems, gaming techniques, doorbells — along with telephones that may take up bandwidth. The extra gadgets related, the upper minimal speeds are wanted to maintain every part working easily.

To fulfill rising wants, federal regulators up to date the definition of broadband final yr, establishing commonplace speeds of 100/20 Mbps. These speeds are sometimes sufficient for a number of customers to stream, browse, obtain, and play video games on the similar time.

Christopher Ali, professor of telecommunications at Penn State, recommends minimal commonplace speeds of 100/100 Mbps. Whereas obtain speeds allow consumption, akin to streaming or procuring, quick add speeds are essential to take part in video calls, say, for work or telehealth.

On the cafe in Howard County, on a cold morning final fall, Wilderson ordered a glass of white wine and his standard: three-seeded bread with spinach, goat cheese, smoked salmon, and over-easy eggs. After consuming, Wilderson held up his wrist: “This watch allows me to track my diabetes without pricking my finger.”

Wilderson mentioned he works together with his medical doctors, feels younger, and expects to dwell effectively into his 90s, simply as his father and grandfather did.

Telehealth is essential for folks in areas with few or no medical suppliers, mentioned Ry Marcattilio, an affiliate director of analysis on the Institute for Native Self-Reliance. The nationwide analysis and advocacy group works with communities on broadband entry and reviewed KFF Well being Information’ findings.

Excessive-speed web makes it simpler to make use of video visits for medical checkups, which most sufferers with diabetes want each three months.

Being related “can make a huge difference in diabetes outcomes,” mentioned Nestoras Mathioudakis, an endocrinologist and co-medical director of Johns Hopkins Medication Diabetes & Schooling Program, who treats sufferers in Howard County.

Paying Extra for Much less

At Williams’ dwelling in Alabama, photos of her siblings and their children cowl the partitions of the hallway and lounge. A big, wood-framed picture of Jesus on the Final Supper together with his disciples hangs over her kitchen desk.

Williams sat down as her pots simmered and sizzled. She wasn’t feeling fairly proper. “I had a glass of orange juice and a bag of potato chips, and I knew that wasn’t enough for breakfast, but I was cooking,” Williams mentioned.

Each evening Williams takes a capsule to regulate her diabetes. Within the morning, if she feels as if her sugar is dropping, she is aware of she must eat. So, that morning, she left the room to seize a peppermint, strolling by the flickering wi-fi router.

The router’s obtain and add speeds had been 0.03/0.05 Mbps, almost unusable by fashionable requirements. Williams’ connection on her home telephone can sound scratchy, and when she connects her cellphone to the router, it doesn’t all the time work. Most days it’s simply ok for her to learn a every day devotional web site and test Fb, although the tales don’t all the time load.

Rural residents like Williams paid almost $13 extra a month on common in late 2020 for sluggish web connections than these in city areas, in line with Brian Whitacre, an agricultural economics professor at Oklahoma State College.

“You’re more likely to have competition in an urban area,” Whitacre mentioned.

In rural Alabama, cellphone and web choices are restricted. Williams pays $51.28 a month to her wi-fi supplier, Ring Planet, which didn’t reply to calls and emails.

In Howard County, Maryland, nationwide fiber-optic broadband supplier Verizon Communications faces competitors from Comcast, a hybrid fiber-optic and cable supplier. Verizon advertises a house web plan promising speeds of 300/300 Mbps beginning at $35 a month for its present cell clients. The corporate additionally provides a reduced worth as little as $20 a month for purchasers who take part in sure federal help applications.

“Internet service providers look at the economics of going into some of these communities and there just isn’t enough purchasing power in their minds to warrant the investment,” mentioned Ross DeVol, chief government of Heartland Ahead, a nonpartisan assume tank primarily based in Bentonville, Arkansas, that focuses on state and native financial improvement.

Conexon, a fiber-optic cable development firm, estimates it prices $25,000 per mile to construct above-ground fiber traces on poles and $60,000 to $70,000 per mile to construct underground.

Former President Joe Biden’s 2021 infrastructure legislation earmarked $65 billion with a aim of connecting all Individuals to high-speed web. Cash was designated to ascertain digital fairness applications and to assist low-income clients pay their web payments. The legislation additionally put aside tens of billions by means of the Broadband Fairness Entry and Deployment Program, referred to as BEAD, to attach houses and companies.

That effort prioritizes fiber-optic connections, however federal regulators lately outlined steerage for different applied sciences, together with low Earth orbit satellites like SpaceX’s Starlink service.

Funding the usage of satellites in federal broadband applications has been controversial inside federal businesses. It has additionally been a sore level for Elon Musk, who’s chief government of SpaceX, which runs Starlink, and is a lead adviser to President Donald Trump.

After preliminary approval, a federal fee dominated that Starlink’s satellite tv for pc system was “not reasonably capable” of providing dependable excessive speeds. Musk tweeted final yr that the fee had “illegally revoked” cash awarded beneath the company’s Trump-era Rural Digital Alternative Fund.

In February, Trump nominated Arielle Roth to guide the federal company overseeing the infrastructure act’s BEAD program. Roth is telecommunications coverage director for the Senate Committee on Commerce, Science, and Transportation. Final yr, she criticized this system’s emphasis on fiber and mentioned it was beleaguered by a “woke social agenda” with too many rules.

Commerce Secretary Lutnick final week mentioned he’ll eliminate “burdensome regulations” and revamp this system to “take a tech-neutral approach.” Republicans echoed his positions throughout a U.S. Home subcommittee listening to the identical day.

When requested about doubtlessly weakening this system’s required low-cost web possibility, former Nationwide Telecommunications and Data Administration official Sarah Morris mentioned such a change would construct web connections that folks can’t afford. Basically, she mentioned, they’d be “building bridges to nowhere, building networks to no one.”

‘That Harm’

Over a lunch of tortilla chips with the savory sauce that had been simmering on the range, Williams mentioned she hadn’t been getting common checkups earlier than her diabetes analysis.

“To tell you the truth, if I can get up and move and nothing is bothering me, I don’t go to the doctor,” Williams mentioned. “I’m just being honest.”

Years in the past, Williams recalled, “my head was hurting me so bad I had to just lay down. I couldn’t stand up, walk, or nothing. I’d get so dizzy.”

Williams thought it was her blood stress, however the physician checked for diabetes. “How did they know? I don’t know,” Williams mentioned.

As lunch ended, she pulled out her glucose monitor. Williams related the needle and wiped her finger with an alcohol pad. Then she pricked her finger.

“Oh,” Williams mentioned, sucking air by means of her enamel. “That hurt.”

She positioned the pattern within the machine, and it shortly displayed a studying of 145 — a quantity, Williams mentioned, that meant she wanted to cease consuming.

Click on to open the Methodology Methodology

Right here’s how KFF Well being Information did its evaluation for the “Dead Zone” collection, which pinpointed counties that lag behind the remainder of the US in entry to broadband service and well being care suppliers.

To determine “dead zones,” KFF Well being Information consulted two foremost information sources.

The Federal Communications Fee Nationwide Broadband Map was used to determine broadband deserts as of June 2024. We used the FCC’s minimal pace commonplace of 100 Mbps obtain and 20 Mbps add, and adopted its definition of dependable broadband: service accessible through wired (fiber optics, cable, DSL) or licensed mounted wi-fi expertise. It’s the usual for grants awarded by means of the federal Broadband Fairness, Entry, and Deployment Program, referred to as BEAD. The FCC information exhibits whether or not such service is offered, and never essentially whether or not households subscribe to it.
Knowledge from George Washington College’s Fitzhugh Mullan Institute for Well being Workforce Fairness was used to find out counties with well being supplier shortages. GWU’s information on main care suppliers (household and inside medication medical doctors, pediatricians, obstetricians and gynecologists, doctor assistants, and nurse practitioners) displays suppliers who serve no less than one individual enrolled in Medicaid. We used the latest years obtainable: 2020 for 44 states, and 2019 information for Texas. 5 states — Delaware, Florida, Maine, Minnesota, and New Hampshire — had been excluded from evaluation as a result of they lacked dependable information for both yr.

GWU’s information for behavioral well being suppliers displays psychiatrists, psychologists, counselors, therapists, and dependancy medication specialists, no matter whether or not their sufferers obtain Medicaid. We used information from 2021, the latest yr obtainable.

We categorized counties as “dead zones” in the event that they met these standards:

Fewer than 70% of houses had entry to quick, dependable broadband.
They ranked within the backside third of Medicaid main care suppliers, outlined because the variety of Medicaid enrollees per supplier.
They ranked within the backside third of behavioral well being suppliers, outlined because the variety of residents per supplier.

A complete of 210 counties met these standards. On the different excessive, we outlined 203 counties as “most served” if that they had essentially the most residences with broadband entry (no less than 96.7%) and ranked within the prime third of Medicaid main care and behavioral well being supplier ratios.

We additionally in contrast the well being outcomes and demographics of useless zone counties relative to others utilizing a number of information sources:

U.S. Census Bureau, for information on family revenue, training ranges, and different demographics.
County Well being Rankings & Roadmaps, a part of the College of Wisconsin Inhabitants Well being Institute, for information on life expectancy and the share of residents residing in rural areas.
U.S. Facilities for Illness Management and Prevention, for information on diabetes, hypertension, and different persistent well being situations.

This challenge was produced in partnership with InvestigateTV. InvestigateTV is Grey Tv’s nationwide investigative group and gives modern, unique journalism from a devoted investigative group and companions, in addition to weekday and weekend exhibits. Grey is the nation’s second-largest tv broadcaster, with tv stations serving 113 markets.

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.

Subscribe to KFF Well being Information’ free Morning Briefing.

This text first appeared on KFF Well being Information and is republished right here beneath a Inventive Commons license.

—

Beforehand Revealed on kffhealthnews.org

***

Does relationship ever really feel difficult, awkward or irritating?

dating header long 1

Flip Your Relationship Life right into a WOW! with our new courses and dwell teaching.
Click on right here for more information or to purchase with particular launch pricing!

***

On Substack? Comply with us there for extra nice relationship and relationships content material.

Be part of The Good Males Undertaking as a Premium Member at the moment.

All Premium Members get to view The Good Males Undertaking with NO ADS. A $50 annual membership provides you an all entry cross. You may be part of each name, group, class and neighborhood. A $25 annual membership provides you entry to at least one class, one Social Curiosity group and our on-line communities. A $12 annual membership provides you entry to our Friday calls with the writer, our on-line neighborhood. Want extra information? A whole listing of advantages is right here.

—

Photograph credit score: unsplash

The submit Hundreds of thousands in US Reside In Locations The place Docs Don’t Follow and Telehealth Doesn’t Attain appeared first on The Good Males Undertaking.

Success Tales

ADVERTISEMENT:

Informasi mengenai KING SLOT, Segera Daftar Bersama king selot terbaik dan terpercaya no satu di Indonesia. Boleh mendaftar melalui sini king slot serta memberikan hasil kembali yang paling tinggi saat sekarang ini hanyalah KING SLOT paling gacor, gilak dan gaco saat sekarang di Indonesia melalui program return tinggi di kingselot serta pg king slot

adu88 permainan paling prime dan garansi imbal balik hasil besar bersama https://adu88.asia/

agoda88 permainan paling prime dan garansi imbal balik hasil besar bersama https://agoda88.asia/

aryaduta88 permainan paling prime dan garansi imbal balik hasil besar bersama https://aryaduta88.com/

bajaringan permainan paling prime dan garansi imbal balik hasil besar bersama https://bajaringan.asia/

bangkit88 permainan paling prime dan garansi imbal balik hasil besar bersama https://bangkit88.biz/
https://basket88.web/

batu88 permainan paling prime dan garansi imbal balik hasil besar bersama https://batu88.biz/

berita88 permainan paling prime dan garansi imbal balik hasil besar bersama https://berita88.biz/

best88 permainan paling prime dan garansi imbal balik hasil besar bersama https://best88.asia/

booking88 permainan paling prime dan garansi imbal balik hasil besar bersama https://booking88.org/

ceria88 permainan paling prime dan garansi imbal balik hasil besar bersama https://ceria88.biz/

cipit888 permainan paling prime dan garansi imbal balik hasil besar bersama https://cipit888.asia/

dinojp88 permainan paling prime dan garansi imbal balik hasil besar bersama https://dinojp88.com/

dosen88 permainan paling prime dan garansi imbal balik hasil besar bersama https://dosen88.org/

eyangslot88 permainan paling prime dan garansi imbal balik hasil besar bersama https://eyangslot88.biz/

f88bet permainan paling prime dan garansi imbal balik hasil besar bersama https://f88bet.asia/

forwin777 permainan paling prime dan garansi imbal balik hasil besar bersama https://forwin777.biz/

gacoan888 permainan paling prime dan garansi imbal balik hasil besar bersama https://gacoan888.biz/

gacor666 permainan paling prime dan garansi imbal balik hasil besar bersama https://gacor666.biz/

gambar88 permainan paling prime dan garansi imbal balik hasil besar bersama https://gambar88.org/

gemoy888slot permainan paling prime dan garansi imbal balik hasil besar bersama https://gemoy888slot.information/

gercep888 permainan paling prime dan garansi imbal balik hasil besar bersama https://gercep888.asia/

gitar88 permainan paling prime dan garansi imbal balik hasil besar bersama https://gitar88.asia/

gmail88 permainan paling prime dan garansi imbal balik hasil besar bersama https://gmail88.org/

grandaston88 permainan paling prime dan garansi imbal balik hasil besar bersama https://grandaston88.com/

grandmercure88 permainan paling prime dan garansi imbal balik hasil besar bersama https://grandmercure88.com/

hermes88 permainan paling prime dan garansi imbal balik hasil besar bersama https://hermes88.biz/

heroslot888 permainan paling prime dan garansi imbal balik hasil besar bersama https://heroslot888.information/

hoki222 permainan paling prime dan garansi imbal balik hasil besar bersama https://hoki222.biz/

holidayinn88 permainan paling prime dan garansi imbal balik hasil besar bersama https://holidayinn88.com/

hotelharis88 permainan paling prime dan garansi imbal balik hasil besar bersama https://hotelharis88.com/

ibis88 permainan paling prime dan garansi imbal balik hasil besar bersama https://ibis88.asia/

ibisbudget88 permainan paling prime dan garansi imbal balik hasil besar bersama https://ibisbudget88.com/

indonesia88 permainan paling prime dan garansi imbal balik hasil besar bersama https://indonesia88.information/

inspirasi permainan paling prime dan garansi imbal balik hasil besar bersama https://inspirasi.information/

janjigacor88 permainan paling prime dan garansi imbal balik hasil besar bersama https://janjigacor88.org/

jitujp88 permainan paling prime dan garansi imbal balik hasil besar bersama https://jitujp88.com/

jokiwin88 permainan paling prime dan garansi imbal balik hasil besar bersama https://jokiwin88.web/

juragan66 permainan paling prime dan garansi imbal balik hasil besar bersama https://juragan66.biz/

jwmarriott88 permainan paling prime dan garansi imbal balik hasil besar bersama https://jwmarriott88.com/

kedai88slot permainan paling prime dan garansi imbal balik hasil besar bersama https://kedai88slot.biz/

kilau88 permainan paling prime dan garansi imbal balik hasil besar bersama https://kilau88.biz/

kimjongun permainan paling prime dan garansi imbal balik hasil besar bersama https://kimjongun.asia/

kiw88 permainan paling prime dan garansi imbal balik hasil besar bersama https://kiw88.biz/

koi777 permainan paling prime dan garansi imbal balik hasil besar bersama https://koi777.biz/

kucing permainan paling prime dan garansi imbal balik hasil besar bersama https://kucing.information/

kudaslot88slot permainan paling prime dan garansi imbal balik hasil besar bersama https://kudaslot88slot.com/

kuncigitar permainan paling prime dan garansi imbal balik hasil besar bersama https://kuncigitar.org/

kuta88 permainan paling prime dan garansi imbal balik hasil besar bersama https://kuta88.asia/

madu888slot permainan paling prime dan garansi imbal balik hasil besar bersama https://madu888slot.web/

maniaslot88 permainan paling prime dan garansi imbal balik hasil besar bersama https://maniaslot88.professional/

maxbet888slot permainan paling prime dan garansi imbal balik hasil besar bersama https://maxbet888slot.com/

mercure88 permainan paling prime dan garansi imbal balik hasil besar bersama https://mercure88.com/

mitra777slot permainan paling prime dan garansi imbal balik hasil besar bersama https://mitra777slot.biz/

mobilelegends88 permainan paling prime dan garansi imbal balik hasil besar bersama https://mobilelegends88.com/

moris88 permainan paling prime dan garansi imbal balik hasil besar bersama https://moris88.org/

motivasi88 permainan paling prime dan garansi imbal balik hasil besar bersama https://motivasi88.com/

nagacc88 permainan paling prime dan garansi imbal balik hasil besar bersama https://nagacc88.com/

nasigoreng88 permainan paling prime dan garansi imbal balik hasil besar bersama https://nasigoreng88.com/

neng88 permainan paling prime dan garansi imbal balik hasil besar bersama https://neng88.biz/

neototo88 permainan paling prime dan garansi imbal balik hasil besar bersama https://neototo88.com/

newslot888 permainan paling prime dan garansi imbal balik hasil besar bersama https://newslot888.biz/

ngopibet88 permainan paling prime dan garansi imbal balik hasil besar bersama https://ngopibet88.org/

nibung888 permainan paling prime dan garansi imbal balik hasil besar bersama https://nibung888.biz/

nonstop888slot permainan paling prime dan garansi imbal balik hasil besar bersama https://nonstop888slot.com/

nova12 permainan paling prime dan garansi imbal balik hasil besar bersama https://nova12.web/

novotel88 permainan paling prime dan garansi imbal balik hasil besar bersama https://novotel88.com/

oli88 permainan paling prime dan garansi imbal balik hasil besar bersama https://oli88.org/

omset88 permainan paling prime dan garansi imbal balik hasil besar bersama https://omset88.com/

orientalplay88 permainan paling prime dan garansi imbal balik hasil besar bersama https://orientalplay88.com/

oxwin88 permainan paling prime dan garansi imbal balik hasil besar bersama https://oxwin88.com/

oyo88 permainan paling prime dan garansi imbal balik hasil besar bersama https://oyo88.dwell/

pahala88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pahala88.biz/

paris777slot permainan paling prime dan garansi imbal balik hasil besar bersama https://paris777slot.biz/

parsel88 permainan paling prime dan garansi imbal balik hasil besar bersama https://parsel88.com/

pesiarbet88slot permainan paling prime dan garansi imbal balik hasil besar bersama https://pesiarbet88slot.web/

pizzahut88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pizzahut88.web/

planet777slot permainan paling prime dan garansi imbal balik hasil besar bersama https://planet777slot.biz/

pmg888 permainan paling prime dan garansi imbal balik hasil besar bersama https://pmg888.biz/

pohon88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pohon88.biz/

polaris888 permainan paling prime dan garansi imbal balik hasil besar bersama https://polaris888.information/

prediksi88 permainan paling prime dan garansi imbal balik hasil besar bersama https://prediksi88.biz/

puas88 permainan paling prime dan garansi imbal balik hasil besar bersama https://puas88.com/

pubg88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pubg88.information/

pulaujudi88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pulaujudi88.information/

puma888 permainan paling prime dan garansi imbal balik hasil besar bersama https://puma888.information/

pusakajitu88 permainan paling prime dan garansi imbal balik hasil besar bersama https://pusakajitu88.com/

qqhok88 permainan paling prime dan garansi imbal balik hasil besar bersama https://qqhok88.org/

quiz88 permainan paling prime dan garansi imbal balik hasil besar bersama https://quiz88.biz/

quiz88slot permainan paling prime dan garansi imbal balik hasil besar bersama https://quiz88slot.com/

rajah permainan paling prime dan garansi imbal balik hasil besar bersama https://rajah.asia/

reddoorz88 permainan paling prime dan garansi imbal balik hasil besar bersama https://reddoorz88.com/

registrasi88 permainan paling prime dan garansi imbal balik hasil besar bersama https://registrasi88.com/

ribut88 permainan paling prime dan garansi imbal balik hasil besar bersama https://ribut88.web/

roblox88 permainan paling prime dan garansi imbal balik hasil besar bersama https://roblox88.org/

rockygerung88 permainan paling prime dan garansi imbal balik hasil besar bersama https://rockygerung88.com/

rumah permainan paling prime dan garansi imbal balik hasil besar bersama https://rumah.asia/

microvip888 permainan paling prime dan garansi imbal balik hasil besar bersama https://microvip888.com

slot demo gacor permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun demo slot gacor permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun slot demo gacor permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun demo slot pragmatic permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun slot demo pragmatic permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun slot demo permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

akun demo slot permainan paling prime dan garansi imbal balik hasil besar bersama https://kdwapp.com/

slot demo gacor

akun demo slot gacor

akun slot demo gacor

akun demo slot pragmatic

akun slot demo pragmatic

akun slot demo

akun demo slot