{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:29:16Z","timestamp":1786728556874,"version":"build-2736575974"},"reference-count":70,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Social Science Foundation Project","award":["25BGL268"],"award-info":[{"award-number":["25BGL268"]}]},{"name":"National Social Science Foundation Project","award":["20FGLB043"],"award-info":[{"award-number":["20FGLB043"]}]},{"name":"Chongqing Graduate Research and Innovation Project","award":["CYB25001"],"award-info":[{"award-number":["CYB25001"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Digital health now serves as a central paradigm for modern health promotion, sparking growing concerns over whether it exacerbates health inequalities. Anchored in China\u2019s \u201cSmart Healthcare and Eldercare\u201d policy (SHE), this study investigates the policy\u2019s impact on older adults\u2019 health outcomes and inequality, offering empirical insights into this critical debate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on 32,634 micro-samples from five waves (2014\u20132023) of the China Longitudinal Aging Social Survey (CLASS), this study employs a multi-period difference-in-differences (DID) approach to identify the causal effects of the SHE pilot policy. Health is characterized by self-rated, mental, and functional health, with corresponding health inequality indices calculated based on the relative deprivation index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results show that SHE significantly improves self-rated health and mental health, with no significant effect on functional ability. The results provide evidence for three mechanisms: healthier behaviors, increased health-related expenditures, and enhanced utilization of community medical and other services. SHE also narrows inequalities in self-rated and mental health, but widens gaps in functional ability. Further analyses show that while the policy improves access to health resources in a broadly universal manner, disparities in older adults\u2019 digital usage capacity hinder the equal translation of technological interventions into functional ability gains. As a result, improvements in functional ability are more concentrated among socioeconomically advantaged groups, leading to widened inequality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms that digital health interventions effectively improve older adults\u2019 health. However, to prevent widening health inequalities, targeted measures like digital literacy training must be implemented for digitally vulnerable groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076261478254","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T18:20:37Z","timestamp":1786558837000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of smart healthcare and eldercare on older adults\u2019 health and health inequality: Evidence from China"],"prefix":"10.1177","volume":"12","author":[{"given":"Mi","family":"Xu","sequence":"first","affiliation":[{"name":"Chongqing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubin","family":"Fan","sequence":"additional","affiliation":[{"name":"Wuhan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Xian","sequence":"additional","affiliation":[{"name":"Chongqing University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1796-0358","authenticated-orcid":false,"given":"Daifu","family":"Yang","sequence":"additional","affiliation":[{"name":"Chongqing University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_6_2_2","unstructured":"WHO. Healthy life expectancy at birth (years). https:\/\/data.who.int\/indicators\/i\/48D9B0C\/C64284D. (2024 accessed January 4 2026)."},{"key":"e_1_3_6_3_2","volume-title":"Report on the Development Trend of \u201cChinese-Style\u201d Elderly Care","author":"Fudan institute on aging, (Fudan institute on aging and 21st Century Business Herald)","year":"2023","unstructured":"Fudan institute on aging, (Fudan institute on aging and 21st Century Business Herald). Report on the Development Trend of \u201cChinese-Style\u201d Elderly Care, 2023."},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.glohj.2019.07.001"},{"key":"e_1_3_6_5_2","first-page":"5","article-title":"Solution and Realizing Path of the Overall Problem of Intelligent Aged Care Service","volume":"6","author":"Liao C","year":"2019","unstructured":"Liao C. Solution and Realizing Path of the Overall Problem of Intelligent Aged Care Service. Rev Econ Manag 2019; 6: 5\u201313. https:\/\/doi.org\/10.13962\/j.cnki.37-1486\/f.2019.06.001","journal-title":"Rev Econ Manag"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-05617-7"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-025-02953-5"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.2196\/14956"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/10410236.2024.2358279"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076251349622"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01737-y"},{"key":"e_1_3_6_12_2","volume-title":"Constitution of the World Health Organization","author":"WHO","year":"1946","unstructured":"WHO. Constitution of the World Health Organization. World Health Organizatio, 1946. https:\/\/www.who.int\/about\/governance\/constitution (accessed December 5, 2025)."},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1086\/259880"},{"issue":"1","key":"e_1_3_6_14_2","first-page":"11","article-title":"Policies and strategies to promote social equity in health","volume":"27","author":"Dahlgren G","year":"1991","unstructured":"Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockh Inst Future Stud 1991; 27(1): 11\u201313.","journal-title":"Stockh Inst Future Stud"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13148-022-01286-8"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-024-01493-6"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-17145-x"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.54.12.923"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0885-y"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241304592"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076251349901"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-10-48"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kaz023"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2015.06.003"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuri.2021.100028"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.116847"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076251326673"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(20)30317-4"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-023-00830-1"},{"key":"e_1_3_6_30_2","first-page":"96","article-title":"How Does Socioeconomic Status Affect Health Among Older Adults? The Mediating and Moderating Roles of Internet Use","volume":"3","author":"Xu Q","year":"2024","unstructured":"Xu Q. How Does Socioeconomic Status Affect Health Among Older Adults? The Mediating and Moderating Roles of Internet Use. J Soc Dev 2024; 3: 96\u2013118+244.","journal-title":"J Soc Dev"},{"issue":"1","key":"e_1_3_6_31_2","first-page":"108","article-title":"Smart Elderly Health Care and Medical Expenses: Evidence from the Smart Elderly Health Care Demonstration Sites","volume":"41","author":"Xie E","year":"2025","unstructured":"Xie E, Yang Y. Smart Elderly Health Care and Medical Expenses: Evidence from the Smart Elderly Health Care Demonstration Sites. J Manag World 2025; 41(1): 108\u2013130. https:\/\/doi.org\/10.19744\/j.cnki.11-1235\/f.2025.0014","journal-title":"J Manag World"},{"key":"e_1_3_6_32_2","volume-title":"Ottawa Charter for Health Promotion","author":"WHO","year":"1986","unstructured":"WHO. Ottawa Charter for Health Promotion. World Health Organization, 1986. https:\/\/www.who.int\/teams\/health-promotion"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/109019817400200407"},{"key":"e_1_3_6_34_2","doi-asserted-by":"publisher","DOI":"10.1258\/jtt.2012.SFT108"},{"key":"e_1_3_6_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2024.06.036"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.2196\/42556"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n740"},{"key":"e_1_3_6_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(01)00006-5"},{"key":"e_1_3_6_39_2","doi-asserted-by":"publisher","DOI":"10.1108\/JPBM-12-2017-1710"},{"key":"e_1_3_6_40_2","doi-asserted-by":"publisher","DOI":"10.2196\/29781"},{"key":"e_1_3_6_41_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.3399889"},{"key":"e_1_3_6_42_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0144686X06005344"},{"issue":"02","key":"e_1_3_6_43_2","first-page":"80","article-title":"The Problem of Old-Age Care in Urban China: Case Studies of Beijing","author":"Mu G","year":"2002","unstructured":"Mu G. The Problem of Old-Age Care in Urban China: Case Studies of Beijing. J Renmin Univ China 2002; (02): 80\u201387.","journal-title":"J Renmin Univ China"},{"key":"e_1_3_6_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-022-02188-8"},{"key":"e_1_3_6_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.im.2024.103956"},{"key":"e_1_3_6_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.119602"},{"key":"e_1_3_6_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40685-020-00125-x"},{"key":"e_1_3_6_48_2","doi-asserted-by":"publisher","DOI":"10.1080\/1369118X.2015.1012532"},{"key":"e_1_3_6_49_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.72.8.800"},{"key":"e_1_3_6_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241310041"},{"key":"e_1_3_6_51_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/61.5.S256"},{"key":"e_1_3_6_52_2","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2019.1602589"},{"key":"e_1_3_6_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/53B.1.S46"},{"key":"e_1_3_6_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/0733464814563607"},{"key":"e_1_3_6_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118809"},{"key":"e_1_3_6_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118604"},{"key":"e_1_3_6_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118624"},{"key":"e_1_3_6_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeconom.2021.03.014"},{"key":"e_1_3_6_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeconom.2020.12.001"},{"issue":"5","key":"e_1_3_6_60_2","first-page":"100","article-title":"Mediating effects and moderating effects in causal inference","author":"Jiang T","year":"2022","unstructured":"Jiang T. Mediating effects and moderating effects in causal inference. China Ind Econ 2022; (5): 100\u2013120. https:\/\/doi.org\/10.19581\/j.cnki.ciejournal.2022.05.005","journal-title":"China Ind Econ"},{"key":"e_1_3_6_61_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-12022-8"},{"key":"e_1_3_6_62_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206"},{"key":"e_1_3_6_63_2","doi-asserted-by":"publisher","DOI":"10.1057\/s41599-024-04312-7"},{"key":"e_1_3_6_64_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231179031"},{"key":"e_1_3_6_65_2","doi-asserted-by":"publisher","DOI":"10.2196\/71460"},{"key":"e_1_3_6_66_2","doi-asserted-by":"publisher","DOI":"10.1177\/0022146510383501"},{"key":"e_1_3_6_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2025.101751"},{"key":"e_1_3_6_68_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076221102261"},{"key":"e_1_3_6_69_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241288316"},{"key":"e_1_3_6_70_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076261427777"},{"key":"e_1_3_6_71_2","doi-asserted-by":"publisher","DOI":"10.1177\/07334648221120082"}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261478254","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076261478254","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261478254","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:28:36Z","timestamp":1786724916000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076261478254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":70,"alternative-id":["10.1177\/20552076261478254"],"URL":"https:\/\/doi.org\/10.1177\/20552076261478254","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"article-number":"20552076261478254"}}