Objective To understand the contract signing and utilization of family doctor services among rural elderly empty nesters in eastern, central and western China and the factors influencing them, thereby providing a basis for improving the health of rural empty nesters.

Methods A total of 2 208 rural empty nesters aged ≥ 60 years from 48 villages in six provinces/municipalities/autonomous regions (Zhejiang and Shandong in eastern China, Henan and Hubei in central China, and Chongqing and Gansu in western China) were selected by stratified random sampling from July 2023 to August 2024. A questionnaire survey was conducted to collect the information on individual characteristics, personal behaviors, interpersonal relationship, community conditions, medical insurance, and contract signing and utilization of family doctor services among rural empty nesters in eastern, central and western China. Furthermore, the factors affecting them were analyzed.

Results The overall contract signing and utilization rates of family doctor services among rural empty nesters were 49.82% and 42.93% in eastern, central and western China, respectively. Specifically, the contract signing and utilization rates were 39.41% and 36.97% in eastern China, 36.46% and 23.80% in central China, and 83.68% and 79.34% in western China, with differences (χ² = 358.842, 450.389, both P < 0.001) among different regions. The results of multifactorial unconditional logistic regression analyses showed that in eastern China, the contract signing and utilization rates of family doctor services were higher for rural empty nesters with annual personal income ≥ 5 000 CNY and lower for rural empty nesters with the educational background of senior high school/technical secondary school and above, frequent social participation, and retirement. In central China, the contract signing rate was higher among rural empty nesters with the educational background of senior high school/technical secondary school and above, home address 1 km to 3 km from the nearest medical service institution, and basic medical insurance for urban workers or commercial medical insurance; the utilization rate was higher among rural empty nesters with the education background of senior high school/technical secondary school and above and chronic diseases; the contract signing rate and utilization rate were lower among retired rural empty nesters. In western China, females, chronic disease patients, and smokers among rural empty nesters demonstrated higher contract signing rates, while chronic disease patients and smokers showed higher utilization rates; the contract signing rate was lower among rural empty nesters who used the Internet and had frequent social participation; the utilization rate was lower among rural empty nesters with the educational background of senior high school/technical secondary school and above and frequent social participation.

Conclusions The contract signing and utilization rates of family doctor services are the highest among the rural empty nesters in western China. The factors influencing the contract signing and utilization of family doctor services among empty nesters were educational background, annual personal income, social participation, and employment in eastern China, educational background and employment in central China, and chronic diseases, smoking, and social participation in western China.