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Background <p>Rehabilitation is a critical health strategy under the dual pressures of aging and disability in China, where the adequate utilization of rehabilitation services plays a pivotal role. Heterogeneity analyses can facilitate the development of more targeted and effective strategies to enhance services use. This study examines the differentiated associations between individual socioeconomic position (SEP) and the utilization of rehabilitation services among older adults with physical disability (PD), taking into account variations in disability severity and marital status.</p> Methods <p>The primary data for this study are drawn from the China Monitoring Survey on Persons with Disabilities (2007 ~ 2013), comprising 19,782 observations of older adults with PD. Interaction effects were evaluated on two scales: the coefficient scale—using logistic regression models with multiplicative interaction terms, and the probability scale—using predicted-probability differences across interaction-defined groups.</p> Results <p>Basic education showed a borderline-significant stronger association with rehabilitation use among those with more severe disability (OR = 1.222, 95% CI 1.007 ~ 1.484, <i>p</i> &lt; 0.05; interaction  effect = 0.046, 95% CI: -0.002 ~ 0.093, <i>p</i> = 0.059). High income also showed marginal evidence of a stronger association among individuals with a spouse (OR = 1.260, 95% CI 1.017 ~ 1.561, <i>p</i> &lt; 0.05; interaction effect = 0.048, 95% CI: -0.004 ~ 0.100, <i>p</i> = 0.068). Probability-scale analyses showed that the interaction between high educational attainment and marital status was not statistically significant. Nevertheless, the direction of the interaction effect was consistent with the coefficient-scale result and the observed patterns of predicted probability distributions, suggesting that the association between high educational attainment and rehabilitation services utilization tended to be somewhat stronger among individuals with a spouse than among individuals without one, although this pattern did not consistently reach statistical significance (OR = 1.719, 95% CI 1.031 ~ 2.866, <i>p</i> &lt; 0.05; interaction effect = 0.102, 95% CI: -0.028 ~ 0.232, <i>p</i> = 0.125).</p> Conclusion <p>There are structural differences in the relationship between the SEP of older people with PD and the utilization of rehabilitation services across groups with varying disability severity and marital status. It is recommended to develop evidence-based protocols to integrate rehabilitation services into family caregiving practices and to promote the integration of professional and informal care through structured caregiver training programs and home-based rehabilitation guidance. </p>

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Heterogeneous associations between socioeconomic position and rehabilitation use among older adults with physical disabilities: moderating roles of disability severity and marital status

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Yiran Wang,
  • Chentao Zhang,
  • Xiaoqian Yan,
  • Le Wang,
  • Wannian Liang

摘要

Background

Rehabilitation is a critical health strategy under the dual pressures of aging and disability in China, where the adequate utilization of rehabilitation services plays a pivotal role. Heterogeneity analyses can facilitate the development of more targeted and effective strategies to enhance services use. This study examines the differentiated associations between individual socioeconomic position (SEP) and the utilization of rehabilitation services among older adults with physical disability (PD), taking into account variations in disability severity and marital status.

Methods

The primary data for this study are drawn from the China Monitoring Survey on Persons with Disabilities (2007 ~ 2013), comprising 19,782 observations of older adults with PD. Interaction effects were evaluated on two scales: the coefficient scale—using logistic regression models with multiplicative interaction terms, and the probability scale—using predicted-probability differences across interaction-defined groups.

Results

Basic education showed a borderline-significant stronger association with rehabilitation use among those with more severe disability (OR = 1.222, 95% CI 1.007 ~ 1.484, p < 0.05; interaction  effect = 0.046, 95% CI: -0.002 ~ 0.093, p = 0.059). High income also showed marginal evidence of a stronger association among individuals with a spouse (OR = 1.260, 95% CI 1.017 ~ 1.561, p < 0.05; interaction effect = 0.048, 95% CI: -0.004 ~ 0.100, p = 0.068). Probability-scale analyses showed that the interaction between high educational attainment and marital status was not statistically significant. Nevertheless, the direction of the interaction effect was consistent with the coefficient-scale result and the observed patterns of predicted probability distributions, suggesting that the association between high educational attainment and rehabilitation services utilization tended to be somewhat stronger among individuals with a spouse than among individuals without one, although this pattern did not consistently reach statistical significance (OR = 1.719, 95% CI 1.031 ~ 2.866, p < 0.05; interaction effect = 0.102, 95% CI: -0.028 ~ 0.232, p = 0.125).

Conclusion

There are structural differences in the relationship between the SEP of older people with PD and the utilization of rehabilitation services across groups with varying disability severity and marital status. It is recommended to develop evidence-based protocols to integrate rehabilitation services into family caregiving practices and to promote the integration of professional and informal care through structured caregiver training programs and home-based rehabilitation guidance.