From disconnection to well-being: a longitudinal study on digital access as a social determinant of health for older adults in China

OBJECTIVES: This study innovatively includes digital access as a social determinant of health (SDoH) to examine the longitudinal relationship between digital inclusion and subjective well-being among older adults in China, one of the largest aging populations worldwide. METHODS: We used data from the Chinese Longitudinal Aging Social Survey (CLASS, 2016 and 2020 waves). We applied the SDoH framework to analyze the interaction between digital inclusion and social structures at the micro, meso, and macro levels. Digital accessibility was captured in waves in 2016 and 2020. Four digital accessibility trajectories were identified: continuous access, gained access, lost access, and never accessed. Subjective well-being is a latent variable constructed from life satisfaction, self-rated health, and social adaptation from CLASS 2020 wave. All other independent variables, including micro-, meso-, and macro-level variables, were measured in the CLASS 2016 wave. Multinomial logistic regression and ordinary least squares analyses were conducted to determine the factors associated with digital inclusion and subjective well-being. RESULTS: Our findings reveal that urban residence, higher education, preretirement occupation, and intergenerational co-residence are significantly associated with increased digital inclusion. Conversely, advanced age and lower socioeconomic status are linked to digital exclusion. Continuous digital access, education, activities of daily living, and social support have been found to positively correlate with enhanced subjective well-being. DISCUSSION: This study recognizes digital inclusion as a key SDoH, emphasizes the structural barriers to digital access, and advocates interventions for enhancing digital literacy, infrastructure, and family/community digital engagement for older adults.