{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:07:38Z","timestamp":1793124458469,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Against the backdrop of an aging population, older adults are confronted with multifaceted challenges, including physiological decline, uneven distribution of medical resources, and economic constraints, which collectively exacerbate their health vulnerability. This study aims to examine the impact of primary healthcare accessibility on health vulnerability among older adults and to explore disparities in access to primary care services across different demographic groups, thereby providing an empirical foundation for promoting healthy aging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An online survey was conducted among 398 older adults in China to assess health vulnerability and accessibility to village clinics and township health centers. A baseline model and a multi-group structural equation model were used to analyze the effect of primary healthcare accessibility on health vulnerability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>While overall health vulnerability among older adults remained relatively high, accessibility to primary healthcare services was generally favorable. Compared to village clinics, township health centers have significantly higher accessibility. Furthermore, demographic variables such as gender, education level, and marital status demonstrated heterogeneous effects within this relationship.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Policy efforts should prioritize enhancing resource allocation and service capacity at the village clinic level. Concurrently, greater attention should be devoted to ensuring healthcare equity for vulnerable subgroups, including women, those living alone, and individuals with lower educational attainment, within the primary healthcare system. These measures will contribute to reducing health vulnerability among older adults and advancing the goal of healthy aging.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1656886","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T04:17:29Z","timestamp":1760329049000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of access to primary healthcare services on health vulnerability among older adults in China: focusing on demographic differences"],"prefix":"10.3389","volume":"13","author":[{"given":"Ningli","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenwen","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.6018\/analesps.479721","article-title":"Self-perceived and reported mental health in older adults (Salud mental autopercibida e informada en personas mayores)","volume":"38","author":"Tom\u00e1s","year":"2024","journal-title":"Ann Psychol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1089\/tmj.2016.0045","article-title":"The empirical foundations of telemedicine interventions in primary care","volume":"22","author":"Bashshur","year":"2016","journal-title":"Telemed J E Health"},{"key":"ref4","first-page":"112","article-title":"The impact of primary health care utilization on the subjective well-being of rural older adults: evidence from CLASS data","volume":"39","author":"Lu","year":"2025","journal-title":"Chin J Popul Sci"},{"key":"ref5","author":"Zhai","year":"2023"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e736","DOI":"10.1016\/S2666-7568(21)00184-7","article-title":"Frailty assessment in the care of older people with haematological malignancies","volume":"2","author":"Goede","year":"2021","journal-title":"Lancet Healthy Longev"},{"key":"ref7","year":""},{"key":"ref8","doi-asserted-by":"publisher","first-page":"100019","DOI":"10.1016\/j.lanwpc.2020.100019","article-title":"Primary health care in China","volume":"3","year":"2020","journal-title":"Lancet Reg Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"8074","DOI":"10.1073\/pnas.1231335100","article-title":"A framework for vulnerability analysis in sustainability science","volume":"100","author":"Turner","year":"2003","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"150","DOI":"10.13793\/j.cnki.42-1020\/c.2021.05.017","article-title":"Analysis on impact of community elderly care services on Chinese seniors\u2019 vulnerability?","volume":"48","author":"Dasong","year":"2021","journal-title":"J Hubei Normal Univ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/00012272-198304000-00008","article-title":"Risk and vulnerability: a case for differentiation","volume":"5","author":"Rose","year":"1983","journal-title":"Adv Nurs Sci"},{"key":"ref12","first-page":"219","article-title":"Frailty: evaluation and management","volume":"103","author":"Allison","year":"2021","journal-title":"Am Fam Physician"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/j.cjca.2016.03.020","article-title":"Conceptual models of frailty: accumulation of deficits","volume":"32","author":"Rockwood","year":"2016","journal-title":"Can J Cardiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"23227","DOI":"10.1038\/s41598-024-74194-x","article-title":"Enhancing the convenience of frailty index assessment for elderly Chinese people with machine learning methods","volume":"14","author":"Huang","year":"2024","journal-title":"Sci Rep"},{"key":"ref15","first-page":"52","article-title":"Health cumulative deficit index and its validity among the Chinese elderly","volume":"5","author":"Gu","year":"2009","journal-title":"Popul. 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