Association between social participation and medical care utilization among rural older adults in China: a longitudinal study based on the CLHLS (2011-2018)

Abstract

Background: There is limited understanding regarding the patterns and trajectories of social participation and their associations with medical care utilization among rural older adults. We aimed to investigate the patterns and trajectories of social participation and their associations with medical care utilization among rural older adults in China using longitudinal data.

Methods: In this longitudinal study, we used data from 1600 participants aged 60 years and above in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We included participants with social participation information in 2011 (T1) as the baseline and followed them up in 2014(T2) and 2018(T3). Latent profile analysis (LPA) and latent transition analysis (LTA) were employed to identify the latent classes of social participation and the transition probabilities between these classes. Multinomial logistic regression was used to examine the predictors of transitions, while a two-part model and cross-lagged model were utilized to clarify the longitudinal relationship between social participation and medical care utilization among rural older adults.

Results: Three social participation classes were identified by LPA: low, moderate, and high social participation. The high social participation class exhibited strong stability, with rare transitions to other classes. Subjective economic status, self-rated health, and the number of chronic diseases significantly predicted social participation transition patterns (P < 0.05). Regarding outpatient care utilization, social participation consistently predicted more frequent outpatient visits in all waves (P < 0.05) but was associated with higher outpatient expenses only at T3 (P < 0.05). However, no significant association was observed between social participation and inpatient care utilization. This finding was further supported by cross-lagged modeling, demonstrating significant effects of social participation on outpatient care utilization (β = 0.016 to 0.018, SE = 0.004, P < 0.001).

Conclusions: This research reveals the social participation dynamics in rural older adults and their effects on medical care utilization in China. Social participation can significantly promote outpatient care utilization among rural older adults. Targeted policy and practice are needed for those with low levels of social participation in rural areas.

Keywords: Medical care utilization; Older adults; Rural China; Social participation.

Fig. 1

The sample selection process

Fig. 2

Three social participation patterns by Latent Profile Analysis at T1 (before imposing measurement invariance) Note: X1 means housework (cooking, bringing up children, etc.), X2 means tai chi chuan, X3 means square dancing, X4 means visiting and interacting with friends, X5 means other outdoor activities, X6 means reading books and newspapers, X7 means playing cards or mahjong, X8 means watching TV and listening to the radio, X9 means taking part in organized social activities

Fig. 3

Three social participation patterns by Latent Profile Analysis at T2 (before imposing measurement invariance). Note: X1 means housework (cooking, bringing up children, etc.), X2 means tai chi chuan, X3 means square dancing, X4 means visiting and interacting with friends, X5 means other outdoor activities, X6 means reading books and newspapers, X7 means playing cards or mahjong, X8 means watching TV and listening to the radio, X9 means taking part in organized social activities

Fig. 4

Three social participation patterns by Latent Profile Analysis at T3 (before imposing measurement invariance). Note: X1 means housework (cooking, bringing up children, etc.), X2 means tai chi chuan, X3 means square dancing, X4 means visiting and interacting with friends, X5 means other outdoor activities, X6 means reading books and newspapers, X7 means playing cards or mahjong, X8 means watching TV and listening to the radio, X9 means taking part in organized social activities

Fig. 5

Social participation and outpatient care utilization in 2011, 2014, and 2018

Fig. 6

Social participation and inpatient care utilization in 2011, 2014, and 2018

Fig. 7

Cross-lagged model with social participation and outpatient expenses among rural older adults at three time points. Note: ^***P<0.001

Fig. 8

Cross-lagged model with social participation and inpatient expenses among rural older adults at three time points. Note:^***P<0.001