Factors associated with unmet healthcare needs among community-dwelling older adults in South Korea: a cross-sectional study using KNHANES 2023

Unmet healthcare needs (UHN), defined as perceived need for medical care that is not obtained, are a key indicator of access barriers among older adults. Using recent nationally representative data, this study examined factors associated with UHN among community-dwelling older adults in South Korea within Andersen’s behavioral model framework. We conducted a cross-sectional complex-sample analysis of the 2023 Korea National Health and Nutrition Examination Survey (KNHANES; public release December 2024). Adults aged ≥ 65 years with complete data were included (weighted analysis; n = 1,393). UHN were assessed by self-report of not receiving needed medical care in the past year (yes/no). Predisposing, enabling, and need-related factors, along with health behaviors, were examined. Hierarchical complex-sample logistic regression models were specified a priori, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated. In the fully adjusted model, lower educational attainment was independently associated with higher odds of UHN (≤ elementary: aOR 3.728, 95% CI 1.31–10.64; middle school: aOR 3.022, 95% CI 1.06–8.61; reference: ≥college). Need-related indicators were also associated with UHN, including dizziness/balance problems (aOR 2.358, 95% CI 1.57–3.53), activity limitation (aOR 1.940, 95% CI 1.23–3.06), and poorer health-related quality of life (per 1-point increase in HINT: aOR 1.071, 95% CI 1.02–1.12). Higher health literacy was inversely associated with UHN (per 1-point increase: aOR 0.912, 95% CI 0.79–0.99). Alcohol use (≥ 1/month) was associated with higher odds of UHN (aOR 3.161, 95% CI 1.95–5.12). Household income, residence, insurance indicators, metabolic syndrome, and current smoking were not statistically significant. UHN among Korean older adults were associated with educational disadvantage and health-related vulnerability, including mobility limitations and poorer HRQoL. These findings highlight the importance of addressing navigation-related barriers and functional constraints when considering strategies to improve healthcare access in later life.