Factors associated with traditional Chinese medicine service utilisation across generations and urban-rural populations in Hubei Province, China: a cross-sectional study

Traditional Chinese medicine (TCM) is an important component of healthcare in China, but evidence remains limited on how utilisation varies across generations and between urban and rural populations. This study had two aims: (1) to compare 12-month TCM service utilisation by generation and registered residence; and (2) to identify demographic, socioeconomic, health-need, accessibility, environmental and cultural factors associated with utilisation overall and within generation and urban-rural strata. A cross-sectional survey was conducted in six cities in Hubei Province, China, from August to October 2023. Stratified multistage sampling was used, and 3,639 respondents were included in the final analysis. Multivariable logistic regression was used to identify factors associated with TCM service utilisation, followed by stratified analyses by generation (< 45 years vs. ≥45 years) and registered residence (urban vs. rural). Overall, 48.67% of respondents reported using TCM services. Utilisation was higher among respondents aged ≥ 45 years than among those aged < 45 years (54.99% vs. 47.21%) and higher among urban than rural respondents (49.98% vs. 46.61%). In the overall model, TCM-related and integrated Chinese and Western medicine-related employment and greater regional availability of TCM resources were associated with higher utilisation, whereas good self-rated health was associated with lower utilisation. The middle household-income category, but not the upper category, showed a positive association. The observed patterns of association varied across generation and registered-residence strata. TCM service utilisation in Hubei Province differed by generation and registered residence and was associated with health needs, socioeconomic resources, service accessibility and cultural context. These findings may inform population-specific planning to improve service accessibility and resource allocation.