Background There is growing evidence for the direct and indirect health benefits of social, cultural and community engagement (SCCE) across cultures, including supporting healthy behaviours and improving quality of life. However, it remains unclear whether SCCE is associated with different types of healthcare utilisation. This study aimed to examine the short-term (up to two years) and longitudinal (changes over six years) associations between SCCE and subsequent health service use.

Methods This population-based cohort study used data from the 2008–2016 waves of the Health and Retirement Study (HRS), a nationally representative sample of the United States population aged 50 and over. SCCE was measured with a 15-item Social Engagement scale at baseline and longitudinally. Logistic regression models and Negative binomial regression models were used to compare subsequent healthcare utilisation, including inpatient care (hospital stays, hospital readmission, length of hospital stays), outpatient care (outpatient surgery, physician visits, number of physician visits), dental care, and community healthcare (home healthcare, nursing home stays, nights in a nursing home). Models adjusted for a range of potential predisposing, enabling, and needs confounders by adopting Anderson’s Behavioural Model of Health Services Use.

Results In short-term analyses, SCCE was associated with lower relative risks of the length of hospital stays (IRR=0.75 [95%CI=0.58–0.98]), lower odds of home healthcare (OR=0.75 [95%CI=0.57–0.99]) and nursing home stays (OR=0.46 [95%CI=0.29–0.71]). Participants with more SCCE had greater odds of using outpatient surgery (OR=1.34 [95%CI 1.12–1.60]) and dental care (OR=1.73 [95%CI 1.46–2.05]). Longitudinally, compared to consistent engagement, reduced SCCE or consistent non-participation was associated with more subsequent inpatient care but lower levels of outpatient and dental care use.

Conclusion SCCE was generally associated with more interaction with outpatient and dental care and reduced inpatient and community healthcare utilisation. Engagement could potentially shape beneficial and preventative health-seeking behaviour and optimise healthcare utilisation.