Regional differences in health status and its associations with health behaviors and healthcare utilization among older adults in the context of the COVID-19 pandemic: A cross-sectional study using the 2019~2020 Korean Community Health Survey.

PURPOSE: The financial independence rate (FIR) is an important regional factor that may be associated with older adults' health status in the context of the COVID-19 pandemic. However, a comprehensive examination of older adults' health status, healthcare utilization, and health behaviors by residential area is lacking. This study aimed to analyze regional differences in health status (including physical and mental health) among older adults across two survey years (2019 and 2020), and to examine its associations with health behaviors and healthcare utilization. METHODS: In this descriptive correlational study, data were collected from 74,547 older adults in 2019 and 72,812 in 2020 across metropolitan and non-metropolitan areas categorized by FIR, reflecting local governments' fiscal capacity. RESULTS: In both survey years, older adults living in non-metropolitan areas with below-average FIR had higher odds of unhealthy subjective health status (adjusted odds ratio [AOR]=1.44~1.52, 95% confidence interval [CI]=1.38~1.60) and unhealthy subjective oral health status (AOR=1.26~1.37, 95% CI=1.21~1.44) compared with those in the metropolitan region, along with lower physical activity and greater unmet healthcare needs. The association between region and depressive symptoms was significant in 2019 (AOR=1.09, 95% CI=1.03~1.15) but not in 2020 (AOR=0.95, 95% CI=0.90~1.01). CONCLUSION: Regional disparities in health behaviors and healthcare utilization were observed among older adults, particularly in non-metropolitan areas with below-average FIR. Policies improving healthcare accessibility and chronic disease management, alongside community-based and nurse-led interventions, may help reduce these regional health disparities.