JMIR Publications

ABSTRACT

Background:

Digital health use among older adults is increasing, yet engagement varies by health status and socioeconomic factors. Comparative analyses across nationally representative surveys can clarify these differences and inform strategies to improve engagement.

Objective:

To compare digital health engagement among older adults in the Health Information National Trends Survey and the National Health Interview Survey, determine important predictors related to information seeking, communication with a healthcare provider, and access to test results, and evaluate how variations in survey design and participant composition affect observed associations.

Methods:

We analyzed 2024 data from NHIS (N=8,818) and HINTS (N=2,120) using weighted descriptive statistics and multivariable logistic regression. Outcomes included (1) seeking health information online, (2) communicating with providers digitally, and (3) viewing test results. Models adjusted for sociodemographic characteristics, health conditions, physical activity, and living arrangements. Multimorbidity-stratified analyses were conducted by estimating models separately for participants with 0–1 conditions and those with 2 or more conditions. To examine how differences in participant composition and survey design influence findings, we conducted an additional subset analysis restricted to comparable demographic groups across surveys.

Results:

HINTS consistently had higher levels of digital health engagement than NHIS across all outcomes (e.g., seeking health information: 78.5% vs. 57.8%; contacting providers: 60.5% vs. 42.2%). In NHIS, lower self-rated health was associated with greater information seeking and provider communication, whereas these correlations were smaller and less consistent in HINTS. Depression was a consistent predictor of increased digital health use in both surveys. Higher education, income, and female sex were all associated with increased use, whereas living alone was associated with reduced participation. Multimorbidity-stratified analyses showed stronger associations between poorer perceived health and digital engagement among individuals with multiple chronic conditions in NHIS, while patterns in HINTS were less consistent and more variable across outcomes. Subset analyses showed weaker relationships in HINTS and more consistent results in NHIS, suggesting that differences in survey design and measurement influence observed relationships.

Conclusions:

Older adults' digital health engagement reflects their health needs and inequality, rather than equitable access. Its association with depression suggests ways to incorporate behavioral health and digital navigation support into patient portals. Disparities in education, income, and living alone emphasize the importance of targeted digital literacy and social support. Differences between NHIS and HINTS show that survey design influences observed relationships, and combining evidence from multiple surveys can help inform equitable digital health policy.