Differential associations of the digital divide with health service utilization and household health maintenance expenditure among older adults: evidence from the 2022 China Family Panel Studies

As digital technologies become embedded in health service delivery, the digital divide facing older adults may deepen inequalities in access. This study examined its associations with recent doctor visits, annual medical expenditure, and household health maintenance expenditure, and whether these associations differed by social support type. Using the 2022 China Family Panel Studies (CFPS; n = 4239, aged ≥ 60 years), we constructed a digital divide index via principal component analysis and identified social support types via latent class analysis. Survey-weighted logit and OLS models estimated three outcomes: two-week doctor visits, log-transformed total health expenditure, and log-transformed household health maintenance expenditure. Robustness was assessed via sequential adjustment and propensity score matching; subgroup regressions and interaction tests were conducted by social support type. After adjusting for all covariates, the digital divide was not significantly associated with two-week doctor visits (logit coefficient = 0.281, 95% CI: −0.521 to 1.083, p = 0.490), but was significantly negatively associated with total health expenditure (coefficient = − 1.539, 95% CI: −2.578 to − 0.501, p = 0.004) and household health maintenance expenditure (coefficient = − 2.543, 95% CI: −3.563 to − 1.524, p < 0.001). The negative association with household health maintenance expenditure was the most consistent. Subgroup coefficients for household health maintenance expenditure were negative across all five social support types; interaction tests detected no significant between-group differences. The digital divide showed differential associations with healthcare utilization and household health maintenance expenditure, with the most consistent negative association observed for household health maintenance spending. Maintaining non-digital channels and embedding targeted digital health support in community health promotion activities to help older adults and their families access reliable health maintenance information and make informed spending decisions are recommended. Given the cross-sectional design, the findings are interpreted as associations.