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Distrust of the health care system and self-reported health in the United States

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Abstract

CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States.

OBJECTIVE: To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States.

DESIGN: Random-digit-dialing telephone survey.

PARTICIPANTS: Nine hundred and sixty-one adult residents of the continental U.S.

PRIMARY MEASURES: Distrust of the health care system and self-reported health status.

RESULTS: Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one’s primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status.

CONCLUSIONS: Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved.

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Authors and Affiliations

  1. Department of Medicine, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA

    Katrina Armstrong MD, MSCE, Abigall Rose MD, MPH, Nikki Peters BA, Judith A. Long MD, Suzanne McMurphy PhD & Judy A. Shea PhD

  2. Abramson Cancer Center, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA

    Katrina Armstrong MD, MSCE

  3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA

    Katrina Armstrong MD, MSCE

  4. Leonard Davis Institute of Health Economics, University of Pennsylvania, Pennsylvania, PA, USA

    Katrina Armstrong MD, MSCE, Judith A. Long MD & Judy A. Shea PhD

  5. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Pennsylvania, PA, USA

    Katrina Armstrong MD, MSCE, Judith A. Long MD & Judy A. Shea PhD

Authors
  1. Katrina Armstrong MD, MSCE
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  2. Abigall Rose MD, MPH
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  3. Nikki Peters BA
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  4. Judith A. Long MD
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  5. Suzanne McMurphy PhD
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  6. Judy A. Shea PhD
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Corresponding author

Correspondence to Katrina Armstrong MD, MSCE.

Additional information

The authors have no conflicts of interest to report.

Larry Hugick, Margie Engle, and Jonathan Best of Princeton Survey Research Associates

Support: Dr. Armstrong is supported by an American Cancer Society Research Scholar Grant, a Robert Wood Johnson Generalist Faculty Scholar Award and RO1 2689-01 from the National Human Genome Research Institute.

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Armstrong, K., Rose, A., Peters, N. et al. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med 21, 292–297 (2006). https://doi.org/10.1111/j.1525-1497.2006.00396.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00396.x

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