The Role of Internet Access in Health Inequality Across Cities in China

Abstract Within the framework of the rapid urbanisation and digitalisation in China, health inequalities remain present regardless of the life expectancy improvement and the expansion of universal health coverage. Recent findings indicate that digital infrastructure can influence the development of these gaps because it influences health information access, prevention behaviour and utilisation of health services. This paper is an ecological cross-sectional study representing the relationship between digital access and health inequality in 30 Chinese cities using the official administrative data of 2023–2024 to create a Digital Ecosystem Index based on standardised z-scores of internet penetration and mobile phone penetration as well as a Health Inequality Index based on z-scores of Helicobacter pylori prevalence, soil-transmitted helminth infections prevalence, tuberculosis incidence, and the prevalence of anaemia caused by iron deficiency and reliability. The Digital Ecosystem Index was negatively related to the Health Inequality Index (β = −0.857, p < .001) as per the results from multiple linear regression that accounted for 93.9 percent of the variance in the Health Inequality Index variable (adjusted R² = .929). Health inequality levels were lower in high-status cities than in low-status cities (β = −0.605, p = .035), while population size showed a modest positive association. Diagnostic checks showed that there was no multicollinearity and non-standard regression assumptions violations. These findings imply that the burden of infectious and nutritional health outcomes appears to be lower in cities with wider and deeper spread of internet access, and indicates that investment in digital infrastructure, especially in low- and middle-tier cities, would be a viable path to enhancing health equity in the changing urban context in China.