Hong Y Alicia, Zhou Zi, Fang Ya, Shi Leiyu
School of Public Health, Xiamen University, Xiamen, China.
School of Public Health, Texas A&M University, College Station, TX, United States.
J Med Internet Res. 2017 Sep 11;19(9):e317. doi: 10.2196/jmir.7786.
The digital divide persists despite broad accessibility of mobile tools. The relationship between the digital divide and health disparities reflects social status in terms of access to resources and health outcomes; however, data on this relationship are limited from developing countries such as China.
The aim of this study was to examine the current rates of access to mobile tools (Internet use and mobile phone ownership) among older Chinese individuals (aged ≥45 years), the predictors of access at individual and community levels, and the relationship between access to mobile tools and health outcomes.
We drew cross-sectional data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which focused on the older population (aged ≥45 years). We used two-level mixed logistic regression models, controlling for unobserved heterogeneity at the community and individual levels for data analysis. In addition to individual-level socioeconomic status (SES), we included community-level resources such as neighborhood amenities, health care facilities, and community organizations. Health outcomes were measured by self-reported health and absence of disability based on validated scales.
Among the 18,215 participants, 6.51% had used the Internet in the past month, and 83% owned a mobile phone. In the multivariate models, Internet use was strongly associated with SES, rural or urban residence, neighborhood amenities, community resources, and geographic region. Mobile phone ownership was strongly associated with SES and rural/urban residence but not so much with neighborhood amenities and community resources. Internet use was a significant predictor of self-reported health status, and mobile phone ownership was significantly associated with having disability even after controlling for potential confounders at the individual and community levels.
This study is one of the first to examine digital divide and its relationship with health disparities in China. The data showed a significant digital divide in China, especially in the older population. Internet access is still limited to people with higher SES; however, the mobile phone has been adopted by the general population. The digital divide is associated with not only individual SES but also community resources. Future electronic health (eHealth) programs need to consider the accessibility of mobile tools and develop culturally appropriate programs for various social groups.
尽管移动工具已广泛普及，但数字鸿沟依然存在。数字鸿沟与健康差异之间的关系反映了在获取资源和健康结果方面的社会地位；然而，来自中国等发展中国家的关于这种关系的数据有限。
本研究旨在调查中国老年人（年龄≥45岁）当前使用移动工具的比例（互联网使用情况和手机拥有情况）、个体和社区层面的使用预测因素，以及使用移动工具与健康结果之间的关系。
我们从一项具有全国代表性的调查——中国健康与养老追踪调查（CHARLS）中提取了横断面数据，该调查聚焦于老年人群（年龄≥45岁）。我们使用两级混合逻辑回归模型，在数据分析中控制社区和个体层面未观察到的异质性。除了个体层面的社会经济地位（SES）外，我们还纳入了社区层面的资源，如邻里设施、医疗保健设施和社区组织。健康结果通过基于有效量表的自我报告健康状况和无残疾情况来衡量。
在18215名参与者中，6.51%的人在过去一个月使用过互联网，83%的人拥有手机。在多变量模型中，互联网使用与SES、农村或城市居住情况、邻里设施、社区资源和地理区域密切相关。手机拥有情况与SES和农村/城市居住情况密切相关，但与邻里设施和社区资源的相关性较小。互联网使用是自我报告健康状况的重要预测因素，即使在控制了个体和社区层面的潜在混杂因素后，手机拥有情况与残疾状况也显著相关。
本研究是首批调查中国数字鸿沟及其与健康差异关系的研究之一。数据显示中国存在显著的数字鸿沟，尤其是在老年人群中。互联网接入仍然仅限于社会经济地位较高的人群；然而，手机已被普通人群所采用。数字鸿沟不仅与个体的社会经济地位有关，还与社区资源有关。未来的电子健康（eHealth）项目需要考虑移动工具的可及性，并为不同社会群体制定符合文化背景的项目。
