Objective To explore the potential multidimensional health transition patterns of the middle-aged and elderly and their impact on healthcare service utilization from the perspective of physical, psychological, and social dimensions, incorporating potential population heterogeneity, and to provide insights for promoting healthy aging.

Methods Using four waves of data (2011-2018) from the China Health and Retirement Longitudinal Study (CHARLS), we applied repeated measurement latent class analysis to identify potential multidimensional health transition patterns among middle-aged and elderly. A two-part model was employed to analyze the impact of these patterns on healthcare service utilization. The first part used a logit model to determine whether healthcare services were utilized, while the second part took linear regression and negative binomial regression models for cost and frequency, respectively.

Results Seven distinct multidimensional health transition patterns were identified the among middle-aged and elderly: “Deteriorating Psychological Health” (11.11%), “Deteriorating Social Health” (27.89%), “Poor Physical and Social Health” (7.02%), “Poor Psychological and Social Health” (13.44%), “Persistently Unhealthy” (7.09%), “Death During Follow-up” (10.46%), and “Persistently Healthy” (22.98%). These health transition patterns significantly influenced both outpatient and inpatient healthcare service utilization, particularly regarding whether outpatient services were used, whether hospitalization occurred, and the frequency of outpatient visits. Compared to the “Persistently Healthy” group, the “Deteriorating Psychological Health,” “Poor Physical and Social Health,” “Poor Psychological and Social Health,” and “Persistently Unhealthy” groups had higher probabilities of utilizing both outpatient and inpatient services. The “Deteriorating Social Health” group (OR=0.83, 95%CI: 0.70-0.98) had a lower probability of utilizing outpatient services (P<0.05). The “Deteriorating Psychological Health” (β=0.30, 95%CI: 0.03-0.58) and “Persistently Unhealthy” (β=0.33, 95%CI: 0.00-0.65) groups incurred higher outpatient service costs (P<0.05), while the “Poor Physical and Social Health” group (β=0.28, 95%CI: 0.03-0.52) had higher inpatient service costs (P<0.05). The “Deteriorating Psychological Health” (IRR=1.48, 95%CI: 1.27-1.73), “Deteriorating Social Health” (IRR=1.19, 95%CI: 1.03-1.38), “Poor Physical and Social Health” (IRR=1.28, 95%CI: 1.06-1.55), “Poor Psychological and Social Health” (IRR=1.39, 95%CI: 1.18-1.64), and “Persistently Unhealthy” (IRR=1.49, 95%CI: 1.25-1.78) groups had a higher frequency of outpatient service utilization (P<0.05). The “Deteriorating Psychological Health” group also had a higher frequency of inpatient service utilization (IRR=1.15, 95%CI: 1.01-1.32) (P<0.05).

Conclusions Seven heterogeneous multidimensional health transition patterns exist among middle-aged and elderly in China. These patterns differentially affect the cost and frequency of outpatient and inpatient service utilization.