Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China (Preprint)

Abstract

UNSTRUCTURED The urban-rural disparities in health outcomes in China is remarkable. The Internet has shown the potential to reduce the risk of disease. However, very little known on the effects of Internet use in alleviating urban-rural inequities. This study aims to examine mediation and moderation of health disparities between urban and rural old adults through Internet usage. Data were drawn from the China Health and Retirement Longitudinal Study 2018 dataset. Basic activities of daily living, brief Community Screening Instrument for Dementia and Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function and depressive symptoms, respectively. Logistic regressions testing “Internet usage*urban-rural status” interactions for moderation and Karlson–Holm–Breen (KHB) decomposition for mediation were performed. Internet use moderated the urban-rural disparities in cognitive function (OR=7.327, 95%CI: 3.011 to 17.832) and depressive symptoms (OR=1.070, 95%CI: 1.037 to 1.787), but the moderating effects were significant only for those using the Internet daily. KHB results showed the suppression effects of using the Internet daily (β=0.012, 95%CI: 0.002 to 0.021) existed in the association of urban-rural status with cognitive function. Part of the urban-rural disparity in depressive symptoms is attributed to the differences in Internet usage (β=-0.027, 95%CI: -0.043 to -0.009). The effect of urban-rural status on mental health among the elderly is moderated and mediated by Internet usage in China. Providing convenient channels for the rural elderly to use the Internet and promoting Internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.