Social Determinants of Digital Health Intervention Use in Mainland China: A National Cross-Sectional Study (Preprint)

BACKGROUND : Digital health interventions (DHIs), including telemedicine and artificial intelligence–enabled health tools, are increasingly integrated into health care systems worldwide. While these technologies have the potential to improve access and efficiency, unequal access to digital resources and health capabilities may create disparities in their use. Evidence on population-level determinants of digital health use remains limited in rapidly digitalizing health systems such as China. OBJECTIVE This study aimed to examine social and structural determinants of DHI use among adults in mainland China using the World Health Organization’s Social Determinants of Health (SDoH) framework. METHODS This cross-sectional study analyzed data from a nationally representative survey conducted in mainland China in 2024 among adults aged ≥18 years. The primary outcome was self-reported ever use of digital health interventions, including telemedicine, digital health applications, and AI-enabled health tools. Explanatory variables were categorized into five SDoH domains: economic stability, education and health-related capabilities, health care access and quality, neighborhood and built environment, and social and community context. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between social determinants and DHI use. RESULTS Among 34,672 participants, 14,565 (42.0%) reported ever using a DHI. Higher household income (≥6001 CNY vs ≤3000 CNY: aOR, 1.37; 95% CI, 1.29–1.46), higher educational attainment (bachelor’s degree or above vs junior high school or below: aOR, 1.49; 95% CI, 1.38–1.61), higher health literacy (per SD increase: aOR, 1.10; 95% CI, 1.07–1.13), and higher eHealth literacy (per SD increase: aOR, 1.20; 95% CI, 1.17–1.24) were associated with greater odds of DHI use. Health insurance coverage was associated with higher DHI use (aOR, 1.22; 95% CI, 1.11–1.34), whereas individuals aware of but not enrolled in family doctor services had lower odds (aOR, 0.65; 95% CI, 0.60–0.70). Difficulty paying medical expenses was associated with higher DHI use (aOR, 1.31; 95% CI, 1.22–1.41), while rural residence was associated with lower odds (aOR, 0.94; 95% CI, 0.89–1.00). CONCLUSIONS DHI use in China is strongly associated with socioeconomic resources, health-related capabilities, and access to health care. These findings highlight the importance of addressing structural and social determinants to promote equitable adoption of digital health technologies in rapidly digitalizing health systems. CLINICALTRIAL NA