Digital Inclusion Pathways for Older Chinese Adults in the Context of Active Aging: Secondary Analysis of 2023 China...

Rapid population aging and the intensifying digitalization of everyday life are unfolding simultaneously in China. While prior studies have largely examined pairwise associations among digital inclusion, social engagement, mental health, and overall health status, few have evaluated an integrated, theoretically grounded pathway linking these domains in later life.

This study aims to quantify the direct and indirect pathways through which digital inclusion influences older adults' overall health status, social engagement, and mental health, specified as sequential mediators.

We analyzed the newly released, nationally representative data from the 2023 wave of the China Longitudinal Aging Social Survey, comprising 9918 adults aged 60 years or older. Overall health status was assessed using 3 self-rated health (SRH) indicators: current SRH, SRH relative to age peers, and SRH relative to last year. Digital inclusion was measured through digital access, device proficiency, and digital ability. Social engagement captured social support, frequency of participation in community or voluntary activities, and nononline activities. Mental health included depressive symptoms, social adaptation, and life satisfaction. Analyses included descriptive statistics, multivariable hierarchical linear regressions, and structural equation modeling to estimate direct and mediated effects (2-sided; α=.05).

Older age, chronic disease, and functional limitations were associated with poorer overall health status, whereas higher education and current employment were associated with better health status. Digital inclusion was positively associated with social engagement (β=.50), which in turn was positively associated with mental health. Mental health showed the strongest association with SRH (β=.74). The direct path from social engagement to overall health status was nonsignificant (P=.34), indicating that participation influences health primarily through psychological pathways. In regression analyses, digital inclusion modestly improved model fit for health status outcomes, while adding mental health produced a greater increase.

Digital inclusion promoted active aging indirectly, by expanding social engagement and enhancing mental health, thereby improving overall health status. Policy efforts should prioritize narrowing the digital divide by improving digital skills and capability, rather than access alone. Meaningful opportunities for social engagement should also be expanded to strengthen community-based mental health support. In addition, strategies should be tailored to the differing needs of urban and rural settings.