Digital exclusion, functional limitations transitions, and life expectancy: a multinational longitudinal study.

Objective: This study examined associations between digital exclusion and functional limitations transitions, and quantified impacts on life expectancy across diverse international contexts. Methods: We analyzed 124,332 adults aged ≥50 years across 23 countries using five harmonized longitudinal aging cohorts. Functional limitations were classified into functional independence, mild and severe functional limitations, with death as an absorbing state. Continuous-time multi-state Markov models examined associations between digital exclusion and transition patterns, while life expectancy was calculated through numerical integration of model parameters. Results: Digital exclusion demonstrated significant associations with adverse functional limitations transitions. Progression to mild limitations in three countries and Europe showed hazard ratios (HRs) of 1.47 (95% CI: 1.23-1.75) to 2.56 (95% CI: 1.38-4.75), and to severe limitations in four countries (excluding Europe) showed HRs of 1.24 (95% CI: 1.06-1.45) to 1.81 (95% CI: 1.15-2.86), while recovery from severe limitations was impaired in England, the United States and Europe (HR: 0.55 [95% CI: 0.48-0.62] to 0.74 [95% CI: 0.62-0.88]). Digital exclusion was associated with reductions in both functional life expectancy (3.72 years in Mexico to 14.27 years in China at age 50) and total life expectancy, with reductions largest at younger ages yet persisting through age 90; conversely, functional limitations duration increased in some countries. Conclusions: Digital exclusion is associated with functional limitations and reduced life expectancy, with associations varying across national contexts and most pronounced among younger age groups. Findings underscore the need to integrate digital inclusion into healthy aging policies while maintaining non-digital healthcare pathways.