Internet use and healthcare utilization among older adults in China: a nationally representative cross-sectional study

Abstract

Background: Research on whether Internet use is related to older adults’ health service use is limited. Hence, this study aimed to empirically examine the associations between Internet use and the different types of healthcare utilization among Chinese older adults and whether there were urban or rural differences. Methods: This study used large-scale nationwide data for Chinese older adults from the 2018 China Longitudinal Aging Social Survey (CLASS). The main explanatory variables were general Internet use and different types of Internet usage, including usage for communication, entertainment, and as instruments. The outcome measures included outpatient and inpatient care utilization, specifically examining the choice of health providers after an illness, the rate of outpatient care utilization after an illness, hospital admission, and the number of hospital admissions in the past two years. Logistic regression, zero-inflated negative binomial regression, and multinomial logistic regression were conducted to assess the associations between Internet use and healthcare utilization. Given the potential urban-rural disparities in Internet use, we applied an interaction term between Internet use and urban-rural status in each model to examine its moderating effects. The potential bias was addressed using the propensity score matching (PSM) method. Results: Compared with older adults who did not use the Internet, Internet users had a lower probability of hospital admission in the past two years (OR: 0.63, 95% CI: 0.55–0.72), fewer hospital admissions (IRR: 0.80, 95% CI: 0.69–0.93), and a higher probability of choosing outpatient care in hospitals after an illness (RRR: 1.22, 95% CI: 1.01–1.47). Using the Internet for communication showed the strongest association with healthcare utilization among different types of Internet use. The urban/rural interaction term was negatively associated with outpatient care utilization but positively associated with inpatient care utilization. Conclusions: This study highlights the important role of the Internet in shaping healthcare utilization, particularly in addressing urban-rural disparities. Implementing Internet-based interventions among older adults is recommended to reduce disparities and improve healthcare access.