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. 2017 Sep 11;19(9):e317.
doi: 10.2196/jmir.7786.

The Digital Divide and Health Disparities in China: Evidence From a National Survey and Policy Implications

Y Alicia Hong #  1   2 , Zi Zhou #  1 , Ya Fang  1 , Leiyu Shi  3
Affiliations

The Digital Divide and Health Disparities in China: Evidence From a National Survey and Policy Implications

Y Alicia Hong et al. J Med Internet Res. .

Abstract

Background: The digital divide persists despite broad accessibility of mobile tools. The relationship between the digital divide and health disparities reflects social status in terms of access to resources and health outcomes; however, data on this relationship are limited from developing countries such as China.

Objective: The aim of this study was to examine the current rates of access to mobile tools (Internet use and mobile phone ownership) among older Chinese individuals (aged ≥45 years), the predictors of access at individual and community levels, and the relationship between access to mobile tools and health outcomes.

Methods: We drew cross-sectional data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which focused on the older population (aged ≥45 years). We used two-level mixed logistic regression models, controlling for unobserved heterogeneity at the community and individual levels for data analysis. In addition to individual-level socioeconomic status (SES), we included community-level resources such as neighborhood amenities, health care facilities, and community organizations. Health outcomes were measured by self-reported health and absence of disability based on validated scales.

Results: Among the 18,215 participants, 6.51% had used the Internet in the past month, and 83% owned a mobile phone. In the multivariate models, Internet use was strongly associated with SES, rural or urban residence, neighborhood amenities, community resources, and geographic region. Mobile phone ownership was strongly associated with SES and rural/urban residence but not so much with neighborhood amenities and community resources. Internet use was a significant predictor of self-reported health status, and mobile phone ownership was significantly associated with having disability even after controlling for potential confounders at the individual and community levels.

Conclusions: This study is one of the first to examine digital divide and its relationship with health disparities in China. The data showed a significant digital divide in China, especially in the older population. Internet access is still limited to people with higher SES; however, the mobile phone has been adopted by the general population. The digital divide is associated with not only individual SES but also community resources. Future electronic health (eHealth) programs need to consider the accessibility of mobile tools and develop culturally appropriate programs for various social groups.

Keywords: China; Internet; digital divide; health disparities; mobile phone.

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Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Chou WS, Liu B, Post S, Hesse B. Health-related internet use among cancer survivors: data from the health information national trends survey, 2003-2008. J Cancer Surviv. 2011 Sep;5(3):263–70. doi: 10.1007/s11764-011-0179-5. - DOI - PubMed
    1. McCully SN, Don BP, Updegraff JA. Using the Internet to help with diet, weight, and physical activity: results from the health information national trends survey (HINTS) J Med Internet Res. 2013 Aug 01;15(8):e148. doi: 10.2196/jmir.2612. http://www.jmir.org/2013/8/e148/ - DOI - PMC - PubMed
    1. DiMaggio P, Hargittai E, Celeste C, Shafer S. From unequal access to differentiated use: a literature review and agenda for research on digital inequality. In: Neckerman K, editor. Social Inequality. New York: Russell Sage Foundation; 2004. pp. 355–400.
    1. Hale T. Is there such a thing as an online health lifestyle? Information, Communication & Society. 2013 May;16(4):501–18. doi: 10.1080/1369118X.2013.777759. - DOI
    1. NTIA. Falling through the net: defining the digital divide https://www.ntia.doc.gov/report/1999/falling-through-net-defining-digita... .