Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California.
Ann Fam Med. 2021 Jan-Feb;19(1):4-15. doi: 10.1370/afm.2632.
Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults.
We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models.
Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; <.001).
Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.
尽管我们知道少数族裔更有可能不信任医疗保健系统，但对于这一人群中对这种医疗不信任的相关因素，我们知之甚少。在这项研究中，我们探讨了代表性成年人样本中医疗不信任的相关因素。
我们分析了 2019 年加利福尼亚成年人关于严重疾病和临终关怀的调查的横断面研究数据。我们确定了种族/民族、健康状况、感知歧视、人口统计学、社会经济因素和医疗不信任。对于数据分析，我们使用了多项逻辑回归模型。
分析基于 704 名非西班牙裔黑人成年人、711 名西班牙裔成年人和 913 名非西班牙裔白人成年人。种族/民族背景与医疗不信任程度显著相关。在调整所有协变量后，报告医疗不信任的几率分别是非西班牙裔黑人成年人和西班牙裔成年人比非西班牙裔白人成年人高 73%（调整后的优势比[aOR] = 1.73；95%置信区间，1.15-2.61，<.01）和 49%（aOR = 1.49；95%置信区间，1.02-2.17，<.05）。感知歧视也与更高的医疗不信任几率相关。由于收入和保险而感到歧视与医疗不信任几率增加 98%相关（aOR = 1.98；95%置信区间，1.71-2.29，<.001）。同样，由于种族/民族背景和语言而感到歧视与医疗不信任几率增加 25%相关（aOR = 1.25；95%置信区间，1.10-1.43；<.001）。
感知歧视与医疗不信任相关。如果这种关联是因果关系，也就是说，如果感知歧视导致医疗不信任，那么减少这种歧视可能会提高医疗临床医生的信任，并减少健康结果的差异。出于与社会正义相关的许多原因，在医疗保健环境中解决歧视是合适的。需要更多的纵向研究来了解复杂的社会、经济、心理和历史因素如何导致医疗不信任。这种类型的研究反过来可能会为设计基于多层次社区和理论的培训模型提供信息，以提高医疗保健临床医生的结构能力，从而减少医疗不信任。
