Distribution, inequalities and associated factors of unmet medical needs among older adults: evidence from the national health service survey

Background Analyzing and addressing the unmet medical needs (UMNs) of older adults is one of the key agendas for health systems to achieve the goals of universal health coverage. This study aims to investigate the distribution, determinants, and inequalities of UMNs among Chinese older adults. Methods The data used from the 2023 National Health Service Survey in Hainan, with a sample of 4112 adults aged 60 and above. Chi-square tests and binary logistic regression were used to examined the factors associated with UMNs. Concentration indices and concentration curves to reflect the health inequalities in UMNs, and a decomposition approach was further employed to examine the contribution of each factor to these inequalities. Results 21.60% of the sample reported UMNs. Compared to the reference group, older adults who are of the Li ethnic group, had no personal income, did not participate in social activities, had no access to aging services, had a higher number of chronic diseases, and not physically independent had a higher likelihood of UMNs ( P < 0.05). Additionally, socioeconomic-related health inequalities existed in the UMNs of the older adults, with a higher concentration among those with poorer economic condition, lower educational level, and those living in the western region ( P < 0.01). The top three contributing factors to these inequalities were ethnicity (-47.03%), number of chronic diseases (-36.93%), and household per capita income (-25.36%). Conclusions The UMNs of the older adults and the potential threat to inequalities require the attention of policymakers. Interventions should focus on improving access to medical services, with a particular emphasis on addressing the needs of vulnerable populations.