Background: While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. Methods: Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. Results: Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. Conclusions: In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas.

BACKGROUND The community health service system was initially established in the rural areas of mainland China, but the utilization of community health service resources by the rural elderly population is not clear. OBJECTIVE In this study, evidence was combined to identify the factors that influence the use of health services, to reveal the gaps in community health services in rural China and the barriers that affect the usage of primary health services by the elderly population. METHODS Cross-sectional studies on the utilization of community health services by the rural elderly in mainland China published within the last ten years were retrieved from the China National Knowledge Infrastructure (CNKI), Wanfang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programmer (CASP), and obstacles to the utilization of community health services by the rural elderly population were analysed based on the Andersen model. RESULTS 24 studies were analysed, including 20 high-quality articles and 4 medium-quality articles. Three gaps were found: (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of elderly residents. (iii) The health services provided by rural primary health service institutions are not targeted. CONCLUSIONS The current situation of the utilization of community health services by the rural elderly population in mainland China is not optimistic. Several factors from the individual to the system level lead to low access and low utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas. CLINICALTRIAL PROSPERO registration number: CRD42021226794