Digital divide and health status among rural older adults in China: evidence from CHARLS

BACKGROUND: Digital inequality may be associated with health disparities in rural ageing populations, yet its cognitive and social pathways and contextual conditions remain insufficiently understood. OBJECTIVES: To examine associations between a multidimensional digital divide and health status among rural older adults in China, evaluate indirect associations through cognitive function and social participation, and assess effect modification by household broadband access and physical activity. METHODS: This was a cross-sectional secondary analysis of rural adults aged ≥60 years from the 2020 China Health and Retirement Longitudinal Study. Regression-based path models with bootstrapped confidence intervals were used to estimate total and indirect associations and interactions, with adjustment for sociodemographic covariates. RESULTS: A larger digital divide was associated with poorer health status. In indirect analyses, cognitive function and social participation partly accounted for the observed association. Broadband access modified the digital divide-cognition association, with a weaker negative association among those with broadband access. Physical activity modified the social participation-health association, which was attenuated at higher activity levels. CONCLUSION: Digital inequality was associated with poorer health among rural older adults, with patterns consistent with cognitive and social pathways and variation by infrastructure and behaviour, suggesting potential targets for reducing digital health disparities.