Beyond access: Digital skills as a new social determinant of health among older adults - evidence from a longitudinal...

As the digital divide shifts from access to skills, the impact of digital competence on older adults' well-being remains underexplored. This study investigates the longitudinal relationship between digital skills and the multidimensional health of China's older population.

Using multi-wave data from the China Longitudinal Aging Social Survey (CLASS), a nationally representative longitudinal panel study, we employed individual fixed-effects models. To mitigate endogeneity, we utilized a Bartik-style instrumental variable (IV-2SLS) strategy. A hybrid analytical approach was adopted to examine transmission mechanisms.

Self-rated digital skills significantly predicted better health outcomes, including improved self-rated health (β=0.082, p < 0.001), fewer depressive symptoms (β=-0.307, p < 0.001), and greater social health (β=0.280, p < 0.001). These associations remained robust after correcting for endogeneity. The protective effect operates through a dual trajectory: reinforcing social participation and health behaviors, while enabling meaningful engagement with digital health technologies. Heterogeneity analysis revealed a pattern of "inclusive growth": health returns were substantial for vulnerable groups (low income/education) and the oldest-old, functioning as a "compensatory resource," though a "digital blind spot" persisted in peri‑urban areas.

Digital skills have emerged as a pivotal social determinant of health in later life. Policies must pivot from infrastructure provision to "precision empowerment," prioritizing skill-building for disadvantaged older adults to ensure the equitable distribution of digital health benefits.