Research on the Impact of Social participation on Health level and Health equity of the middle-aged and elderly in China based on CHARLS2018: the moderation effect of health services utilization

Abstract Objective Social participation is a determinant of active aging and has a significant impact on the health of the middle-aged and elderly. This study aims to analyses the impact of social participation on health level and health equity among the middle-aged and elderly in China, and examines the moderating role of health services utilization. Methods Data are extracted from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative survey for people in China aged 45 years and more. The Orderly Logistic model is used to empirically analyze the impact of social participation on health level and health inequality, and the role of health services utilization is explored. The Propensity Score Matching (PSM) is used to further test robustness. Results This study found that social participation significantly reduces health inequality and improves the physical and mental health of middle-aged and elderly residents. Health services utilization plays an important moderating role between social participation and physiological health and health inequality. Specifically, the higher the degree of health services utilization of middle-aged and elderly residents, the stronger the positive contribution of social participation to their physiological health, which is conductive to improving health equity. These findings remain robust after propensity score matching. Conclusion Social participation significantly affects the health level of middle-aged and elderly residents, and health services utilization, economic situation and health behavior are also important risk factors of health. Therefore, the government should improve the social participation support system of middle-aged and elderly residents, and promote active social participation among the middle-aged and elderly, especially the moderate participation of younger elderly, which is not only beneficial to health promotion, but also greatly beneficial to economic and social development, and effectively contribute to healthy aging of China in the long run.