Digital divide and healthcare service utilization among older adults with chronic liver disease in China: a nationwide cross-sectional study

The digital divide may exacerbate healthcare disparities among vulnerable populations. However, evidence regarding its impact on healthcare utilization among chronic liver disease (CLD) patients remains limited, particularly using comprehensive multidimensional assessments. This study aimed to investigate the association between multidimensional digital divide and healthcare service utilization among Chinese adults with CLD. We analyzed data from 405 CLD patients (aged ≥ 45 years) from the China Health and Retirement Longitudinal Study (CHARLS) Wave 5 (2020). Digital divide was assessed through a comprehensive framework incorporating access, usage, and application dimensions, measured by internet use, device diversity, usage breadth, WeChat use, and mobile payment capability. Healthcare service utilization was defined as any hospitalization in the past year or outpatient visit in the past month. Multivariable logistic regression models, subgroup analyses, and sensitivity analyses including alternative outcome definitions, quartile analysis, and propensity score matching were performed. Among participants (median age 58.2 years, 51.6% male), 53.1% experienced digital divide. Healthcare service utilization was significantly lower among those with digital divide (hospitalization: 13.5% vs. 27.4%, P = 0.001; outpatient visits: 21.9% vs. 56.8%, P < 0.001). After full adjustment, standardized digital divide dimensions showed strong associations with healthcare utilization: access dimension (OR = 2.89, 95%CI: 2.18–3.84), usage dimension (OR = 3.13, 95%CI: 2.34–4.17), application dimension (OR = 1.67, 95%CI: 1.33–2.10), and overall score (OR = 3.63, 95%CI: 2.66–4.94). Significant age interactions were observed (P < 0.001). Sensitivity analyses confirmed robustness, with propensity-matched analysis showing OR = 2.63 (95%CI: 1.53–3.75). Multidimensional digital divide substantially impacts healthcare service utilization among CLD patients. Targeted interventions addressing digital disparities are needed to ensure equitable healthcare access in the digital era.