JMIR Publications

ABSTRACT

Background:

Rapid population aging and the digitalization of everyday life are unfolding simultaneously in China. While prior studies have largely examined pairwise associations among digital inclusion, social engagement, mental health, and overall health status, fewer have tested an integrated pathway that connects these domains to overall health in later life.

Objective:

To quantify the direct and indirect pathways through which digital inclusion influences older adults’ health status, with social engagement and mental health specified as sequential mediators.

Methods:

We analyzed nationally representative data from the 2023 wave of the China Longitudinal Aging Social Survey (CLASS 2023). After excluding observations with missing values on study variables, the analytic sample included 9,918 adults aged ≥60 years. Overall health status was proxied by three self-rated health (SRH) indicators: current SRH, SRH relative to age peers, and SRH relative to last year. Digital inclusion was measured as access, device proficiency, and digital ability. Social engagement encompassed social support, frequency of participation in community/voluntary activities, and non-online activities. Mental health included depressive symptoms, social adaptation, and life satisfaction. We conducted descriptive analyses, multivariable hierarchical linear regressions, and structural equation modeling (SEM) to estimate direct and mediated effects (two-sided,α = .05).

Results:

Age, chronic disease, and functional limitations were associated with poorer health status, whereas higher education and current employment were associated with better health status. Digital inclusion was positively associated with social engagement (β=0.50). Social engagement, in turn, was positively associated with mental health, and mental health showed the strongest association with SRH (β=0.74). The direct path from social engagement to overall health status was not significant, indicating that participation operates primarily through improved mental health to influence overall health perception. In regression models, adding digital inclusion modestly improved model fit for health status outcomes, while adding mental health produced the largest increase.

Conclusions:

Digital inclusion promotes active aging chiefly indirectly by expanding social engagement and enhancing mental health, which together improves health status. Policy should prioritize narrowing the digital divide (skills and capability, not only access), broadening meaningful opportunities for social engagement, strengthening community-based mental health support, and implementing differentiated strategies for urban and rural settings. Future research should leverage longitudinal data and incorporate objective health measures to strengthen causal inference and evaluate potential risks (e.g., information overload), thereby maximizing the benefits of digital inclusion for healthy aging.