Does living alone reshape healthcare use? Longitudinal evidence from older adults in China

China's rapid population aging and shrinking family structures challenge healthcare access for older adults, especially those living alone. While the link between solitary living and poor health is well-documented, its underlying mechanisms remain unclear. This study examines how living alone shapes healthcare-seeking preferences and behaviors to elucidate its pathways to health in later life.

Using longitudinal data from the China Family Panel Studies (2010-2020), restricted to a sample of adults aged 60 and above, we employed a linear probability model with individual and time fixed effects to examine the impact of living alone on two key outcomes: the probability of consulting a doctor when ill (n = 3,911) and the preference for primary healthcare centers (PHCs) (n = 11,956). The model controlled for a set of covariates including demographic characteristics, family attributes, and health status measures. Heterogeneity analyses were conducted by gender, hukou status, and household income.

Living alone was associated with a significant reduction in the probability of consulting a doctor (20.2% points), with the effect more pronounced among older women, suggesting that emotional or psychological barriers may exacerbate their vulnerability. In contrast, older adults living alone demonstrated a stronger preference for PHCs (10.9% points), a tendency that was particularly evident among lower-income and urban residents, likely due to the greater accessibility, lower cost, and shorter waiting times of PHCs.

Strengthening community-based interventions and enhancing the quality and coverage of primary care-particularly in rural areas-are essential to reducing treatment delays and promoting early care-seeking. Policy efforts should prioritise the unique vulnerabilities of older women, low-income individuals, and rural residents by addressing emotional barriers, improving health literacy, and enhancing the accessibility of services. Rebuilding trust in primary care requires sustained investment in provider professionalism, facility infrastructure, and efficient referral systems.