JMIR Publications

ABSTRACT

Background:

Health inequalities among older adults are becoming increasingly pronounced as the aging process progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities.

Objective:

This study aims to investigate the relationship between the digital divide and health inequality among older adults, and to offer recommendations for promoting health equity.

Methods:

Data were obtained from the 2018 and 2020 waves of China Health and Retirement Longitudinal Study(CHARLS). Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, Instrumental Activities of Daily Living (iADL) scale, Mini-Mental State Examination (MMSE) scale, and a 5-point self-rated health scale, respectively. The chi-square and rank-sum tests were used to explore whether Internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using Propensity Scores Matching (PSM), and heterogeneity was analyzed for the different influencing factors.

Results:

The 2018 analysis highlighted widening health disparities among older adults due to Internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL (5.8%), and cognition (7.5%). Similarly, Internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that Internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL (2.1%), iADL (3.5%), and cognition (7.5%), with significant results except for ADL. Internet use also narrowed disparities, with effects on self-rated health (4.8%) and cognition (12.8%) showing statistical significance. The results remained robust through PSM paired tests. In addition, the results of this study showed heterogeneity in Internet access and use on health inequalities among older adults in terms of gender, age, education and region.

Conclusions:

The impact of Internet access and use on health inequalities among older adults shows different trends in 2018 and 2020. This suggests the importance of focusing on and addressing the challenges and barriers to Internet use among older adults, particularly during the initial stages of internet adoption. It is recommended to promote more equitable access for older adults to the health benefits offered by the Internet through policy guidance, social support, and technological advancements.