Abstract
BACKGROUND: China is experiencing rapid population aging amid longstanding but gradually narrowing disparities in health resource allocation. As insurance coverage, primary care capacity, and basic service availability become increasingly equitable, variations in healthcare-seeking behaviors have become a key pathway through which socio-economic differences are reproduced as health inequalities. This study examined the distribution, latent patterns, and socio-demographic correlates of five representative healthcare-seeking behaviors among older adults in China. METHODS: A cross-sectional survey was conducted among 1,500 older adults in Fuzhou and Xiamen, Fujian Province. Five key healthcare-seeking behaviors were assessed: routine physical examination, use of online medical services, first visit in primary care, delay in seeking treatment, and concomitant prescription–over-the-counter drug use. Latent class analysis (LCA) was used to identify unobserved behavior patterns, and Two-Step Cluster Analysis (TCA) was applied as a robustness check for class stability. Multinomial logistic regression (MLR) was then performed to assess socio-demographic correlates of class membership, with the Passive Symptom-Management Group specified a priori as the reference category. RESULTS: Three distinct behavior patterns emerged: a Proactive Health Management Group with high engagement in preventive and digital health services; a Reactive Primary-Care Group characterized by high reliance on primary care but limited preventive behavior; and a Passive Symptom-Management Group marked by delayed care and self-medication. LCA and TCA produced largely comparable classifications. Class membership varied significantly by gender, age, income, education, household registration, and self-reported health. CONCLUSIONS: Healthcare-seeking behaviors among older Chinese adults are increasingly stratified along socio-economic lines, and these behavioral differences function as mechanisms through which structural health inequalities are sustained even when service availability is relatively equitable. Targeted and class-specific interventions are required, including efforts to strengthen digital access, improve health literacy, and promote proactive engagement with primary care among socio-economically disadvantaged groups. Such measures may help mitigate the emerging behavioral divides in later life. ETHICS: The study was approved by the Ethics Committee of Fujian Medical University (IRB No. 2023 − 152). Written informed consent was obtained from all participants. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13882-4.