Individual digital literacy, area-level digital exclusion, and inequalities in exercise participation among middle-aged and older adults: evidence from China

Abstract

Background Although digital exclusion has been widely discussed in relation to healthcare access and digital service use, less is known about its implications for exercise participation among middle-aged and older adults. This study examined how individual digital literacy and area-level digital exclusion jointly shape exercise participation in China. Methods Data were drawn from three waves of the China Health and Retirement Longitudinal Study (CHARLS; 2013, 2015, and 2018) and linked to city-year indicators from the China Statistical Yearbook. The analytic sample included 13,085 person-wave observations from 9,201 unique respondents across 111 cities. Exercise participation was measured as a binary indicator of engagement in exercise-oriented physical activity. Individual digital literacy was assessed using a composite index of digital access, internet use, device resources, and digital behaviors. Area-level digital exclusion was measured using a reverse-coded city-year indicator of contextual digital exclusion. Mixed-effects logistic regression models were used to estimate the associations of individual digital literacy and area-level digital exclusion with exercise participation and to test their cross-level interaction. Results 37.7% of observations reported exercise participation, increasing from 27.5% in 2013 to 40.3% in 2018. In fully adjusted models, higher individual digital literacy was associated with greater odds of exercise participation (OR = 1.11, 95% CI: 1.022–1.208, p < 0.05). Area-level digital exclusion was negatively associated with exercise participation; although the association was attenuated after adjustment for demographic and socioeconomic characteristics, it remained statistically significant in the fully adjusted model (OR = 0.94, 95% CI: 0.869–0.991, p < 0.05). The interaction between individual digital literacy and area-level digital exclusion was negative and significant (OR = 0.96, 95% CI: 0.929–0.984, p < 0.01), indicating that the positive association between digital literacy and exercise participation was weaker in more digitally excluded cities. Conclusion Individual digital literacy was positively associated with exercise participation among middle-aged and older adults in China, whereas area-level digital exclusion weakened this beneficial association. Policies promoting healthy aging should address both older adults’ digital literacy and the broader digital exclusion in which they live.