Objective　To examine temporal trends in health literacy among older adults in China from 2012 to 2022 and to explore potential macro-level correlates.

Methods　Relevant studies were retrieved from CNKI, WanFang Data, VIP, the Chinese Doctoral and Master's Theses Database, Web of Science, and PubMed. Studies on health literacy involving adults aged 60 years and above in mainland China were included. Sample size, mean, standard deviation, year of data collection, the gender, urban and rural sources,the mean and standard deviation of health literacy related indicators of the study subjects were extracted. Cross-temporal Meta-analysis combined with correlation analysis, sample-size-weighted regression and effect size estimation was used to examine temporal changes in overall health literacy, its dimensions, and sex- and urban-rural differences, as well as their associations with the national urbanization rate and the proportion of internet users aged 60 years and above.

Results　A total of 39 studies involving 222,811 older adults were included, extracting 50 annual data sets. From 2012 to 2022, overall health literacy among older adults in China increased significantly over time (r=0.379, β=0.359, both P < 0.01). Healthy lifestyle and behavior (r=0.441, β=0.444, both P < 0.01) and basic knowledge and concepts (r=0.362, β=0.342, both P < 0.05) also showed upward trends, whereas basic skills did not change significantly. Health literacy increased over time in both male and female older adults, with a relatively small average effect size for sex differences. Urban older adults had higher health literacy levels and a more pronounced upward trend than rural older adults, and urban-rural disparities persisted over time. National urbanization rate and the proportion of internet users aged 60 years and above were correlated with temporal changes in health literacy among older adults.

Conclusion　Health literacy among older adults in China showed an overall upward trend from 2012 to 2022. Targeted skill-oriented health education should be carried out among older adults, with strengthened efforts in rural areas and improved age-friendly digital health support. The relationship between macro-level social factors and changes in health literacy requires further examination.

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