Digital divide as a determinant of health in the U.S. older adults: prevalence, trends, and risk factors.

Background: The rapid development of digital technologies has fundamentally changed the care for older adults. However, not all older adults have equal opportunities to access and use the technologies, more importantly, be able to benefit from the technologies. We aimed to explore (1) the prevalence and the trend in the prevalence of digital divide in older adults, including digital access gap, digital use gap (specifically, using digital technologies for health commutation [e-communication gap]), and self-efficacy in information seeking gap (cognitive gap); (2) sociodemographic factors related to three perspectives of digital divide; and (3) the association between digital divide and self-rated health (exploratory).

Methods: Adults aged 65 years or older (N = 5,671, weighted mean [SD] age = 74.26 [10.09] years) from the Health Information National Trends Surveys (2017-2020) were analyzed using the weighted logistic and linear regression models.

Results: There was a significant linear decrease in the adjusted prevalence of digital access gap (odds ratio [OR] = 0.86, 95% CI = 0.78, 0.94) and the e-communication gap (OR = 0.88, 95% CI = 0.82, 0.95) over time. However, there were no significant changes in cognitive gap between 2017 and 2019, and between 2018 and 2020. Overall, older adults with digital divide were more likely to be less educated, have less income, and self-identified as Hispanic people. Univariate analyses found that three perspectives of digital divide were significantly associated with poor self-rated health. Multivariate analyses adjusted for covariates (e.g., age and sex) found that the access gap but not the e-commutation gap was associated with self-rated health and that cognitive gap was only associated with self-rated health between 2018 and 2020 but not between 2017 and 2019.

Conclusions: Digital divide is decreasing but remains persistent and disproportionately affects self-rated health of older adults, particularly those who are socially disadvantaged (e.g., lower education and income). Continued efforts are needed to address digital divide among them.