Wemrell Maria, Hassan Mariam, Perez-Vicente Raquel, Lindström Martin, Öberg Johan, Merlo Juan
Department of Social Work, Faculty of Social Sciences, Linnaeus University, Växjö, Sweden.
Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
Front Public Health. 2025 Jun 11;13:1557921. doi: 10.3389/fpubh.2025.1557921. eCollection 2025.
Trust in healthcare is central to the delivery of care and unequally distributed between groups in society. Experiences of perceived discrimination have been associated with lack of such trust. Although the importance of trust in healthcare has been highlighted in recent years, studies in this area are relatively scarce.
We investigated the risk of low trust in healthcare in Sweden, using data from 11 consecutive National Public Health Surveys conducted in 2004-2014 ( = 83,135). Applying an analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of low trust in healthcare across intersectional strata defined by experiences of perceived discrimination as well as sex/gender, educational level, migration status and age. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI). The area under the receiver operating characteristic curve (AUC) was computed to evaluate the discriminatory accuracy (DA) of the intersectional strata.
The overall prevalence of low trust in healthcare was 25.9%. While low trust was more common among individuals born abroad, with low education and of younger age, discrimination increased the risk of low trust in healthcare over and above the sociodemographic characteristics. The strata with the highest risk of low trust were foreign-born men aged 55-64 years with low income who had experienced discrimination (PR 3.13 [95% CI 2.49-3.95]) and foreign-born women aged 25-34 years with high education who had experienced discrimination (PR 3.05 [95% CI 2.50-3.73]). The DA of the intersectional strata was small (AUC = 0.64), indicating large overlaps between and heterogeneities within strata.
As experiences of discrimination, in healthcare and elsewhere, are associated with lack of trust in healthcare, it is incumbent on healthcare professionals to maintain trustworthiness by mitigating discriminatory practices including through striving toward patient-centered communication and care. Such efforts should be universal, although proportionally tailored to mitigate discrimination against patients with a migration background.
对医疗保健的信任是提供医疗服务的核心，且在社会群体之间分布不均。感知到歧视的经历与缺乏这种信任有关。尽管近年来对医疗保健中信任的重要性已得到强调，但该领域的研究相对较少。
我们利用2004年至2014年连续进行的11次全国公共卫生调查（n = 83,135）的数据，调查了瑞典对医疗保健信任度低的风险。应用个体异质性和歧视准确性分析（AIHDA），我们调查了在由感知到的歧视经历以及性别、教育水平、移民身份和年龄所定义的交叉阶层中，对医疗保健信任度低的风险。我们计算了特定阶层的患病率和患病率比（PR）以及95%置信区间（CI）。计算了受试者工作特征曲线下面积（AUC）以评估交叉阶层的歧视准确性（DA）。
对医疗保健信任度低的总体患病率为25.9%。虽然在国外出生、教育程度低和年龄较小的个体中，信任度低更为常见，但歧视会增加对医疗保健信任度低的风险，且超出社会人口学特征的影响。信任度低风险最高的阶层是55至64岁、低收入且经历过歧视的外国出生男性（PR 3.13 [95% CI 2.49 - 3.95]）以及25至34岁、受过高等教育且经历过歧视的外国出生女性（PR 3.05 [95% CI 2.50 - 3.73]）。交叉阶层的DA较小（AUC = 0.64），表明阶层之间存在较大重叠且阶层内部存在异质性。
由于在医疗保健及其他领域感知到歧视的经历与对医疗保健缺乏信任有关，医疗保健专业人员有责任通过减少歧视性做法来保持可信度，包括努力实现以患者为中心的沟通和护理。这些努力应该是普遍的，尽管应按比例进行调整以减少对有移民背景患者的歧视。
