BackgroundMobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. ObjectiveThis study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. MethodsThe eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. ResultsThe average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90%) compared with urban students (1298/2720, 47.72%; P