Abstract
BACKGROUND: With the rapid advancement of digital transformation, digital health literacy (DHL) has emerged as a crucial determinant influencing health outcomes and health inequalities among older adults. However, empirical evidence on how DHL affects health inequalities remains relatively limited. This study aims to investigate the association between DHL and health inequalities while analyzing the potential mechanisms through which DHL exerts its influence via mechanism testing among older adults in China. METHODS: From June to November 2024, a multicenter cross-sectional study was conducted by five research groups from four universities in China. DHL was assessed using the eHEALS scale, while health inequalities were measured using an index of relative deprivation. Multivariate regression models examined the association between DHL and health inequalities. The Baron and Kenny stepwise regression method was used to examine the mediating effect, and bias-corrected bootstrap resampling with 5000 iterations was applied to calculate 95% confidence intervals (95% CI) to confirm the significance of the mediating effect. RESULTS: Overall, 8696 valid individuals were included. DHL demonstrated a significant positive association with self-rated health (SRH) (coef = 0.015, P < .01) and a significant negative association with health inequalities (coef = -0.016, P < .01). DHL indirectly reduced health inequalities through the mediating effects of alleviating depressive symptoms (coef = -0.005, 95%CI: -0.0066, -0.0045) and promoting physical activity (coef = -0.001, 95%CI: -0.0020, -0.0011), respectively. However, the role in promoting health service utilization and regulating unhealthy behaviors was not significant. Bootstrap tests confirmed the significance of the mediating role. CONCLUSION: DHL was associated with health inequalities and mitigates them by alleviating depressive symptoms and promoting physical activity. It is recommended that while bridging the digital divide, more attention could be paid to DHL and the translation of competencies among older adults to reduce health disparities and promote equitable aging.