Changes in primary health care service experiences and urban–suburban disparities among Shanghai residents: a two-year comparative study(2023–2024)

Background Primary health care (PHC) is central to achieving universal health coverage, yet longitudinal assessments of residents' experiences—especially regarding urban–suburban disparities—remain scarce. This study aims to examine changes in PHC service experiences among Shanghai residents between 2023 and 2024, identify urban–suburban differences, and explore key influencing factors. Methods A two-wave cross-sectional survey was conducted at 248 community health centers in Shanghai from May to June in 2023 and 2024. The Chinese version of the Primary Care Assessment Tool–Adult Short Version (PCAT-AS) was used. Propensity score matching ensured comparability between survey waves. Descriptive statistics, hypothesis testing, and multiple linear regression were employed to assess temporal changes, regional disparities, and associated predictors. Results Residents reported significantly improved PHC experiences in 2024 across all domains ( P  < 0.001), with the largest gains in service comprehensiveness (+ 0.23) and referral coordination (+ 0.18). Urban residents consistently reported better experiences in continuity, service delivery, and cultural competence, while suburban residents rated higher in first-contact accessibility and service availability. Improvements from 2023 to 2024 were most notable in first-contact accessibility (Δ = +0.11) and comprehensiveness (Δ = +0.10), though domains such as family-centeredness and cultural competence showed limited progress (Δ = +0.01). Multivariate analyses identified residential location, chronic disease burden, psychological distress, and self-rated health as significant predictors of overall PCAT scores. Suburban residence was associated with lower scores (B = − 1.59, P  < 0.001), while comorbidities and psychological distress were linked to higher scores. Conclusion Despite overall improvements in PHC experiences among Shanghai residents, persistent urban–suburban disparities remain. Urban residents benefit more in terms of continuity and service coordination, whereas suburban residents report better access and availability. The narrowing gaps in first-contact accessibility and service comprehensiveness suggest some progress toward equity. Targeted strategies are needed to further bridge structural gaps and address the needs of vulnerable populations, advancing both equity and quality in PHC delivery.