To investigate the current status of inpatient health service utilization, rate and equity among middle-aged and elderly people in rural China, and to explore the contribution of each influencing factor to the inequity of inpatient health services utilization.

The concentration index and concentration curve were used to measure and show the equity of inpatient health service utilization among middle-aged and elderly people in rural areas, and used concentration index decomposition methods to conduct a decomposition analysis.

From 2011 to 2020, the inpatient health service utilization rate for middle-aged and elderly people in rural China was 7.36%, 11.41%, 12.97%, 16.90%, and 21.61%, respectively. From 2011 to 2020, the concentration index of inpatient health service utilization rate among middle-aged and elderly people in rural China was 0.154 2, 0.013 4, 0.084 9, 0.043 6, and 0.050 6, respectively. Economic status, region, and age are the main factors affecting the equity of inpatient health services utilization among middle-aged and elderly people in rural areas.

The inpatient health service utilization is mainly concentrated among the economically well-off population. It is of great significance to reduce the inequity of inpatient health service by narrowing the gap between the rich and the poor and regional disparities, paying attention to the elderly and other groups that are vulnerable to health risks, improving the health insurance system and improving the quality of rural health service.