Digital Divide or Compensatory Dividend? The Longitudinal Impact of Smart Health Monitoring on Intrinsic Capacity Trajectories

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Background: The preservation of intrinsic capacity (IC) is a global public health priority, and digital health technologies offer promising avenues for managing functional decline. However, the longitudinal impact of specific smart monitoring devices on IC trajectories remains underexplored, and theoretical debates persist regarding whether digital interventions exacerbate health inequalities (the “digital divide”) or mitigate them (the “compensatory effect”). Methods: Using a balanced panel of 2432 older adults from the China Longitudinal Aging Social Survey (CLASS 2020–2023), we conducted wave-specific latent profile analyses based on five standardized WHO intrinsic-capacity domains. Modal class assignment and cross-wave profile matching were subsequently used to describe profile stability and transitions. The longitudinal protective association of baseline smart blood pressure (BP) monitor use with IC trajectories was evaluated using multinomial logistic regression with Inverse Probability Weighting (IPW). Exploratory structural path analysis was conducted to examine a potential mediating pathway. Results: The baseline latent profile analysis identified three profiles: Robust Capacity (80.2%), Cognitively Impaired (10.9%), and Sensory Impaired (8.8%). The Sensory Impaired class exhibited strong path dependence, with 62.79% of participants remaining in the same state over three years. Baseline estimates revealed that smart BP monitor usage was significantly associated with a reduced relative risk of transitioning into or remaining in the Sensory Impaired profile (RRR = 0.557, 95% CI: 0.325–0.955). The IPW analysis yielded a directionally consistent estimate (RRR = 0.696), although the association was attenuated and was not statistically significant (p = 0.162). Subgroup and pathway analyses yielded non-significant but suggestive findings, indicating that protective associations might be concentrated among vulnerable groups, particularly women and individuals with lower educational attainment. Conclusions: Smart physiological monitoring interventions demonstrate a longitudinal protective association against the persistence of physical frailty. Rather than definitively bridging the digital divide, targeted medical-grade digital tools may serve as compensatory resources for specific vulnerable subpopulations. These observational associations highlight the need for further quasi-experimental testing before integrating specific digital interventions into community-based chronic care ecosystems.