To analyze the influencing factors of the first visit of elderly people at the grassroots level in China, and further implementing graded diagnosis and treatment policies.

Based on the 2020 CLASS data, 4 444 elderly people were included, and a chi square test was used to analyze the influencing factors of their primary diagnosis behavior. A random forest model was used to rank the importance of variables with significant impact.

The elderly who living in the eastern region (OR=1.791,95% CI:1.421-2.256) and the central region (OR=1.438,95% CI:1.121-1.846), having a general self-evaluation (OR=1.869,95% CI:1.501-2.327) and self-assessment health (OR=2.342,95% CI:1.869-2.936), having two kinds of chronic diseases (OR=1.379,95% CI:1.174-1.621) and more than two kinds of chronic diseases (OR=2.648,95% CI:2.236-3.137), using health intelligent devices (OR=1.192,95% CI:1.032-1.377), using basic health services(OR=1.756,95% CI:1.527-2.020), college degree or above (OR=1.480,95% CI:1.088-2.012), and Internet access (OR=1.184,95% CI:1.015-1.381) are more willing to go to the grass-roots level for first diagnosis.

The first visit rate of elderly people at the grassroots level still needs to be improved. It is necessary to strengthen the publicity effect of grassroots first visit, improve the utilization rate of grassroots health services, encourage elderly people to use health intelligent devices, increase the construction of grassroots medical and health institutions in western regions, and correctly guide elderly people to form good medical habits.