Allen Jennifer D, Fu Qiang, Shrestha Shikhar, Nguyen Kimberly H, Stopka Thomas J, Cuevas Adolfo, Corlin Laura
Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
SSM Popul Health. 2022 Nov 12;20:101278. doi: 10.1016/j.ssmph.2022.101278. eCollection 2022 Dec.
COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together.
We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale.
1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses.
Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.
新冠病毒疾病（COVID-19）疫苗的接种情况未达理想状态，而接种差异加剧了健康不平等。据推测，对医疗保健系统的不信任以及在其他环境中遭受歧视或不公平待遇的经历可能是接种COVID-19疫苗的障碍，尽管迄今为止很少有研究同时调查医疗不信任和感知到的歧视。
我们于2021年4月23日至5月3日在美国18岁及以上成年人的全国样本中进行了一项横断面在线调查。我们评估了COVID-19疫苗的接种情况和接种意愿，以及与经过验证的医疗不信任指数和日常歧视量表的关联。
1449人做出了回应，其中70.2%的人接种了≥1剂COVID-19疫苗，或者表示他们“非常”或“有点”可能在未来接种疫苗。在双变量分析中，疫苗接种状况与年龄、种族/族裔、教育程度、收入、就业、婚姻状况、医疗保险和政党归属显著相关。在多变量分析中，将那些接种了≥1剂疫苗或未来可能接种疫苗的人与那些未接种任何疫苗或不打算接种疫苗的人进行比较，医疗不信任指数每增加一分，接种疫苗的几率独立降低16%（调整后的优势比=0.84；95%置信区间=0.81，0.86）。在双变量或多变量分析中，歧视经历与疫苗接种行为或意愿无关。
医疗不信任与疫苗接种状况和意愿显著相关。提高COVID-19疫苗的接种率可能需要公共卫生和医疗保健官员做出实质性努力，以与尚未完全接种疫苗的人群建立信任。我们建议这些努力应侧重于建立这些实体的“可信度”，这种方法需要从关注纠正个人信念和知识的范式转变，转向承认和解决不信任背后的根本原因。
