A larger digital divide was associated with poorer health status among rural older adults in China, with indirect associations through cognitive function and social participation, and variation by household broadband access and physical activity.
Key Findings
Results
A larger digital divide was associated with poorer health status among rural older adults in China.
Study population: rural adults aged ≥60 years drawn from the 2020 China Health and Retirement Longitudinal Study (CHARLS)
Cross-sectional secondary analysis using regression-based path models with bootstrapped confidence intervals
The digital divide was operationalized as multidimensional, capturing multiple aspects of digital inequality
Adjustment was made for sociodemographic covariates throughout analyses
Results
Cognitive function partly accounted for the association between the digital divide and health status.
Cognitive function was identified as a significant indirect pathway between digital divide and health status
Both cognitive function and social participation were examined together as mediators in the same path model
The indirect association through cognitive function was estimated using bootstrapped confidence intervals
This pathway was identified via regression-based path models with adjustment for sociodemographic covariates
Results
Social participation partly accounted for the association between the digital divide and health status.
Social participation was identified as a second significant indirect pathway between digital divide and health status
The indirect associations through cognitive function and social participation were estimated simultaneously in the path model
Both pathways only 'partly' accounted for the observed association, indicating residual direct association remained
Bootstrapped confidence intervals were used to evaluate statistical significance of indirect associations
Results
Household broadband access modified the association between the digital divide and cognitive function, with a weaker negative association among those with broadband access.
Broadband access was examined as an effect modifier (moderator) in the path model
The digital divide–cognition association was attenuated among rural older adults with household broadband access compared to those without
This suggests infrastructure context conditions the cognitive pathway linking digital inequality to health
Improving reliable rural broadband access was identified as a potential policy target
Results
Physical activity modified the association between social participation and health status, with the association attenuated at higher activity levels.
Physical activity was examined as a behavioral effect modifier in the path model
The social participation–health association was weaker among rural older adults with higher physical activity levels
This suggests physical activity may buffer or substitute some of the health benefits otherwise conveyed through social participation
Feasible community activities were identified as a potential intervention target based on this finding
What This Means
This research suggests that older rural adults in China who face greater digital inequality — meaning they have less access to and ability to use digital technologies — also tend to have worse overall health. The study used data from a large national survey of Chinese adults aged 60 and older conducted in 2020, and it found this connection even after accounting for differences in age, income, and other background factors. Two pathways appear to help explain why: people with a larger digital divide had lower cognitive function and less social participation, and both of these factors were in turn linked to poorer health.
The study also found that context matters. Having broadband internet at home appeared to weaken the negative relationship between digital inequality and cognitive function, suggesting that infrastructure improvements could partly protect cognitive health. Meanwhile, being more physically active appeared to reduce the strength of the connection between social participation and health, possibly because physical activity provides some of the same health benefits that social engagement might otherwise offer.
This research suggests that efforts to improve health among aging rural populations in China could benefit from multiple approaches at once: expanding reliable broadband internet infrastructure in rural areas, providing practical help for older adults to use online health resources, and supporting accessible community activities. Because this was a cross-sectional study (meaning it looked at a single point in time), the findings show associations rather than proven cause-and-effect relationships, and further research would be needed to confirm these patterns over time.
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Ren W, Li J, Tian Y, Liu D, Chen Z, Yang S, et al.. (2026). Digital divide and health status among rural older adults in China: evidence from CHARLS.. Global health action. https://doi.org/10.1080/16549716.2026.2679945