Distrust of the Health Care System and Self-Reported Health in the United States

CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States. OBJECTIVE: To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States. DESIGN: Random-digit-dialing telephone survey. PARTICIPANTS: Nine hundred and sixty-one adult residents of the continental U.S. PRIMARY MEASURES: Distrust of the health care system and self-reported health status. RESULTS: Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status. CONCLUSIONS: Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved

Differences in the Patterns of Health Care System Distrust Between Blacks and Whites

CONTEXT: Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust. OBJECTIVE: To test the hypothesis that racial differences in health care system distrust are more closely linked to values distrust than to competence distrust. DESIGN: Cross-sectional telephone survey. PARTICIPANTS: Two hundred fifty-five individuals (144 black, 92 white) who had been treated in primary care practices or the emergency department of a large, urban Mid-Atlantic health system. PRIMARY MEASURES: Race, scores on the overall health care system distrust scale and on the 2 distrust subscales, values distrust and competence distrust. RESULTS: In univariate analysis, overall health care system distrust scores were slightly higher among blacks than whites (25.8 vs 24.1, p = .05); however, this difference was driven by racial differences in values distrust scores (15.4 vs 13.8, p = .003) rather than in competence distrust scores (10.4 vs 10.3, p = .85). After adjustment for socioeconomic status, health/psychological status, and health care access, individuals in the top quartile of values distrust were significantly more likely to be black (odds ratio = 2.60, 95% confidence interval = 1.03-6.58), but there was no significant association between race and competence distrust. CONCLUSIONS: Racial differences in health care system distrust are complex with far greater differences seen in the domain of values distrust than in competence distrust. This framework may be useful for explaining the mixed results of studies of race and health care-related distrust to date, for the design of future studies exploring the causes of racial disparities in health and health care, and for the development and testing of novel strategies for reducing these disparitie