Digital Disadvantage in Nutrition Services: How Environmental Literacy Gaps Limit Elderly Chinese with Chronic Diseases

Purpose Given the high prevalence of nutrition-related chronic diseases (NRCDs) among the elderly population in China, this study explores the association between digital and non-digital health Nutrition Health Service Support (NHSS) and the Level of Environmental and Health Literacy (LEHL) to foster healthy aging. Methods In this cross-sectional study, the demographic profiles of 752 Chinese older adults were detailed and analyzed, and the level of NHSS and LEHL was determined for those with NRCDs. The linear regression was employed to explore the impact of NHSS and scores across dimensions on the residents’ LEHL. Subgroup analyses were also performed to examine the potential roles of demographic characteristics, disease status, and health indicators in the association between NHSS and LEHL. Results Among the 752 elderly participants, 48.7% were affected by one or more NRCDs. This cross-sectional study involving 752 older adults in China found that the number of NRCDs and the NHSS were positively associated with LEHLQ scores. With low NHSS as a reference, moderate and high NHSS levels were associated with increased LEHLQ scores among Chinese older adults. Furthermore, Stratified analyses revealed that Social environmental support (SES) and Online environmental support (OES)demonstrated the strongest positive association with LEHLQ scores, with the high-support group showing effect sizes 1.3-fold greater than Family environmental support (FES) and 2.5-fold greater than Online environmental support (OES). A linear trend was found for the NHSS and LEHLQ scores between different groups such as different sex, Han population, rural and urban residents, those with an income below 5000 RMB, smokers and non-smokers, drinkers and non-drinkers, normal BMI, older adults with or without NRCD, and older adults with primary school education or below. Conclusion Improving LEHL among Chinese older adults is essential for narrowing health disparities and promoting healthy aging. To address the digital disadvantage in this population, strengthening the NHSS system is critical to ensure equitable access to nutrition-related information and services