Associations between digital health literacy and health inequalities among middle-aged and older adults: an urban-rural disparity perspective.

BACKGROUND: In the digital age, digital health literacy has emerged as a critical factor influencing the physical and mental well-being of middle-aged and older adults. However, the relationship between digital health literacy and health inequalities remains underexplored. This study aims to investigate this association among middle-aged and older adults in urban and rural settings. METHODS: Data were obtained from the 2021 Chinese General Social Survey (CGSS). The final analytical sample consisted of 1,672 respondents from the International Social Survey Programme (ISSP) Health Module after excluding individuals younger than 45 years and those with missing values on key variables. The digital health literacy index was constructed using the entropy weight method, which objectively determines indicator weights based on the relative information contained in each dimension. The linear probability model was employed to examine the relationship between digital health literacy and urban-rural health inequalities, given its straightforward coefficient interpretation and suitability for analyzing interaction effects. RESULTS: Digital health literacy reduces urban-rural disparities in physical health among middle-aged and older adults by 0.2229 points [95% CI (-0.4329, -0.0129), p = 0.037] and in mental health by 0.2410 points [95% CI (-0.3908, -0.0913), p = 0.002], thereby enhancing overall well-being and narrowing health disparities. Heterogeneity analysis reveals that the effects of digital health literacy on reducing urban-rural disparities in physical health are stronger among married individuals, while its benefits for mental health inequalities are more evident among married individuals, those with lower educational attainment, and older adults. Mechanism analysis indicates that digital health literacy mitigates urban-rural health inequalities by promoting health-enhancing behaviors. CONCLUSION: Digital health literacy not only improves the physical and mental well-being of middle-aged and older adults but also effectively reduces urban-rural health inequalities.