Jing Rize, Lai Xiaozhen, Li Long, Wang Hufeng
School of Population and Health, Renmin University of China, Beijing, China.
Bigdata and Responsible Artificial Intelligence for National Governance, Renmin University of China, Beijing, China.
BMC Geriatr. 2025 Mar 5;25(1):150. doi: 10.1186/s12877-025-05798-9.
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.
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.
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.
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.
关于互联网使用是否与老年人的医疗服务利用相关的研究有限。因此，本研究旨在实证检验中国老年人互联网使用与不同类型医疗保健利用之间的关联，以及是否存在城乡差异。
本研究使用了来自2018年中国老年社会追踪调查（CLASS）的全国范围内的大规模中国老年人数据。主要解释变量为一般互联网使用情况和不同类型的互联网使用，包括用于通信、娱乐以及作为工具使用。结果指标包括门诊和住院护理利用情况，具体考察患病后对医疗服务提供者的选择、患病后的门诊护理利用率、住院情况以及过去两年的住院次数。进行逻辑回归、零膨胀负二项回归和多项逻辑回归以评估互联网使用与医疗保健利用之间的关联。鉴于互联网使用可能存在城乡差异，我们在每个模型中应用了互联网使用与城乡状况的交互项来检验其调节作用。使用倾向得分匹配（PSM）方法解决潜在偏差。
与未使用互联网的老年人相比，互联网使用者在过去两年住院的概率较低（OR：0.63，95%CI：0.55 - 0.72），住院次数较少（IRR：0.80，95%CI：0.69 - 0.93），并且患病后选择在医院进行门诊护理的概率较高（RRR：1.22，95%CI：1.01 - 1.47）。在不同类型的互联网使用中，使用互联网进行通信与医疗保健利用的关联最强。城乡交互项与门诊护理利用呈负相关，但与住院护理利用呈正相关。
本研究强调了互联网在塑造医疗保健利用方面的重要作用，特别是在解决城乡差异方面。建议对老年人实施基于互联网的干预措施，以减少差异并改善医疗保健可及性。
