Ryu Soomin, Patel Akash, Allgood Kristi L, Mattingly Delvon T, Hirschtick Jana L, Orellana Robert C, Fleischer Nancy L
Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States.
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, United States.
Vaccine X. 2024 Dec 10;22:100600. doi: 10.1016/j.jvacx.2024.100600. eCollection 2025 Jan.
Uptake of COVID-19 vaccines has stalled in the U.S. Some studies suggest that medical mistrust may be a barrier, but evidence is limited due to cross-sectional designs or convenience sampling.
We examined associations of medical mistrust with COVID-19 vaccine attitudes at baseline and vaccination uptake at follow-up using a population-based sample of Michigan adults with PCR-confirmed SARS-CoV-2 infection. We summed ratings for three items of the Medical Mistrust Index (MMI) to measure trust in healthcare providers. For vaccine attitudes, we averaged ratings for two items on importance of getting the COVID-19 vaccine. For vaccination uptake as ever receiving at least one dose of a COVID-19 vaccine. We conducted (1) linear regression models to examine cross-sectional associations between MMI and vaccine attitudes ( = 3865), (2) modified Poisson regression with robust standard errors to estimate prospective associations between MMI and vaccination uptake ( = 3741), and (3) effect modification and stratified analyses by race and ethnicity.
The mean MMI score was 1.89. The mean of positive vaccine attitudes measure at baseline was 3.45 and the prevalence of receiving a vaccine at follow-up was 75.3 %. Higher MMI was associated with worse vaccine attitudes at baseline (coefficient = -0.64, 95 % confidence interval [CI]: -0.71, -0.56), and lower vaccine uptake at follow-up (adjusted risk ratio: 0.83, 95 % CI: 0.80, 0.86). Both associations were pronounced among non-Hispanic White and another non-Hispanic race and ethnicity individuals.
Understanding drivers of medical mistrust may help rebuild public trust in healthcare systems to promote vaccine uptake and improve public health.
美国新冠疫苗接种工作陷入停滞。一些研究表明，对医疗的不信任可能是一个障碍，但由于采用横断面设计或便利抽样，证据有限。
我们使用密歇根州经聚合酶链反应确诊感染严重急性呼吸综合征冠状病毒2的成年人群样本，研究了基线时对医疗的不信任与新冠疫苗态度以及随访时疫苗接种情况之间的关联。我们对医疗不信任指数（MMI）的三个项目评分进行汇总，以衡量对医疗服务提供者的信任度。对于疫苗态度，我们对关于接种新冠疫苗重要性的两个项目评分求平均值。对于疫苗接种情况，定义为是否曾接种至少一剂新冠疫苗。我们进行了：（1）线性回归模型，以检验MMI与疫苗态度之间的横断面关联（n = 3865）；（2）采用稳健标准误的修正泊松回归，以估计MMI与疫苗接种情况之间的前瞻性关联（n = 3741）；以及（3）按种族和族裔进行效应修正和分层分析。
MMI平均得分为1.89。基线时积极疫苗态度测量的平均值为3.45，随访时接种疫苗的患病率为75.3%。较高的MMI与基线时较差的疫苗态度相关（系数 = -0.64，95%置信区间[CI]：-0.71，-0.56），以及随访时较低的疫苗接种率（调整风险比：0.83，95%CI：0.80，0.86）。这两种关联在非西班牙裔白人和其他非西班牙裔种族及族裔个体中都很明显。
了解医疗不信任的驱动因素可能有助于重建公众对医疗系统的信任，以促进疫苗接种并改善公众健康。
