Lindström Martin, Pirouzifard Mirnabi
Social Medicine and Health Policy, Department of Clinical Sciences and Centre for Primary Health Care Research, Lund University, S-205 02, Malmö, Sweden.
SSM Popul Health. 2022 Apr 27;18:101109. doi: 10.1016/j.ssmph.2022.101109. eCollection 2022 Jun.
To investigate associations between trust in the healthcare system and all-cause, cardiovascular, cancer and other causes mortality.
Prospective cohort study.
A public health questionnaire was conducted in 2008 in Scania, the southernmost part of Sweden, with a 54.1% participation rate with a postal questionnaire and three reminders. In this study 24,833 respondents were included. The baseline questionnaire study was linked to prospective 8.3-year follow-up cause-specific mortality register data. Survival (Cox) regression analyses were conducted.
A 15.2% proportion of respondents reported very high, 59.1% rather high, and 21.7% not particularly high trust in the healthcare system, while 3.2% reported no trust at all and 0.9% did not know. The groups with rather high and not particularly high trust in the healthcare system had significantly lower all-cause mortality than the reference group with very high trust in the healthcare system. These statistically significant results remained throughout the multiple analyses, and were explained by lower cancer mortality in both the rather high and not particularly high trust respondent groups, and lower cardiovascular mortality in the not particularly high trust respondent group. No significant results were observed in the adjusted models for other causes mortality. No significant results were observed for the no trust and don't know categories in the multiple adjusted models, but these groups are small.
The results suggest a comparative advantage of moderate trust compared to very high trust in this setting of long waiting times for cancer and CVD treatment.
调查对医疗保健系统的信任与全因死亡率、心血管疾病死亡率、癌症死亡率及其他死因死亡率之间的关联。
前瞻性队列研究。
2008年在瑞典最南部的斯科讷进行了一项公共卫生问卷调查，通过邮寄问卷及三次提醒，参与率为54.1%。本研究纳入了24,833名受访者。基线问卷调查与前瞻性8.3年特定病因死亡率登记数据相关联。进行了生存（Cox）回归分析。
15.2%的受访者表示对医疗保健系统的信任度非常高，59.1%表示较高，21.7%表示不是特别高，而3.2%表示完全不信任，0.9%表示不知道。对医疗保健系统信任度较高和不是特别高的群体的全因死亡率显著低于对医疗保健系统信任度非常高的参照组。这些具有统计学意义的结果在多次分析中均保持不变，原因是信任度较高和不是特别高的受访者群体的癌症死亡率较低，以及信任度不是特别高的受访者群体的心血管疾病死亡率较低。在其他死因死亡率的调整模型中未观察到显著结果。在多重调整模型中，不信任和不知道类别的结果不显著，但这些群体规模较小。
结果表明，在癌症和心血管疾病治疗等待时间较长的情况下，适度信任相比非常高的信任具有相对优势。
