The alignment of home and community-based services and social isolation in China: a longitudinal analysis

This study investigates the longitudinal relationship between the alignment of home and community-based services (HCBS) and social isolation in China, focusing on the mediating role of psychological well-being. In the Chinese context, HCBS alignment reflects perceived local service availability within a government-led, community-based, and multi-actor care system.

Using five waves (2008-2021) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), analyses included 27,649 observations for contact isolation and 22,931 for activity isolation. HCBS alignment was defined as the match between individual expectations and service availability. Objective social isolation was assessed using two indicators: contact isolation and activity isolation, capturing relational and participation-based dimensions of social disconnection. Logistic regression, mediation analysis, and propensity score alignment were applied to estimate associations and robustness.

Greater HCBS alignment was significantly associated with a lower likelihood of contact isolation and activity isolation. Extended services exhibited the strongest protective effects, with longitudinal benefits in mitigating activity isolation over 6 years (OR = 0.895, p < 0.001), 9 years (OR = 0.894, p < 0.05), and 12 years (OR = 0.787, p < 0.05). Basic and supportive services showed limited and inconsistent associations across time. Mediation analysis indicated that psychological well-being explained 17.6% of the total effect on contact isolation and 10.3% on activity isolation.

Findings underscore the importance of emotionally engaging and expectation-aligned services in mitigating social isolation, with extended services generating the most durable benefits. Strengthening HCBS to address psychosocial and physical needs may support aging-in-place and inform responsive community-based care systems in China and beyond.