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. 2024 Jul 1;7(7):e2424984.
doi: 10.1001/jamanetworkopen.2024.24984.

Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults

Roy H Perlis  1   2   3 , Katherine Ognyanova  4 , Ata Uslu  5 , Kristin Lunz Trujillo  6 , Mauricio Santillana  5 , James N Druckman  7 , Matthew A Baum  8 , David Lazer  5
Affiliations

Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults

Roy H Perlis et al. JAMA Netw Open. .

Abstract

Importance: Trust in physicians and hospitals has been associated with achieving public health goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust.

Objective: To characterize changes in US adults' trust in physicians and hospitals over the course of the COVID-19 pandemic and the association between this trust and health-related behaviors.

Design, setting, and participants: This survey study uses data from 24 waves of a nonprobability internet survey conducted between April 1, 2020, and January 31, 2024, among 443 455 unique respondents aged 18 years or older residing in the US, with state-level representative quotas for race and ethnicity, age, and gender.

Main outcome and measure: Self-report of trust in physicians and hospitals; self-report of SARS-CoV-2 and influenza vaccination and booster status. Survey-weighted regression models were applied to examine associations between sociodemographic features and trust and between trust and health behaviors.

Results: The combined data included 582 634 responses across 24 survey waves, reflecting 443 455 unique respondents. The unweighted mean (SD) age was 43.3 (16.6) years; 288 186 respondents (65.0%) reported female gender; 21 957 (5.0%) identified as Asian American, 49 428 (11.1%) as Black, 38 423 (8.7%) as Hispanic, 3138 (0.7%) as Native American, 5598 (1.3%) as Pacific Islander, 315 278 (71.1%) as White, and 9633 (2.2%) as other race and ethnicity (those who selected "Other" from a checklist). Overall, the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71.5% (95% CI, 70.7%-72.2%) in April 2020 to 40.1% (95% CI, 39.4%-40.7%) in January 2024. In regression models, features associated with lower trust as of spring and summer 2023 included being 25 to 64 years of age, female gender, lower educational level, lower income, Black race, and living in a rural setting. These associations persisted even after controlling for partisanship. In turn, greater trust was associated with greater likelihood of vaccination for SARS-CoV-2 (adjusted odds ratio [OR], 4.94; 95 CI, 4.21-5.80) or influenza (adjusted OR, 5.09; 95 CI, 3.93-6.59) and receiving a SARS-CoV-2 booster (adjusted OR, 3.62; 95 CI, 2.99-4.38).

Conclusions and relevance: This survey study of US adults suggests that trust in physicians and hospitals decreased during the COVID-19 pandemic. As lower levels of trust were associated with lesser likelihood of pursuing vaccination, restoring trust may represent a public health imperative.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Perlis reported receiving funding for consulting or service on scientific advisory boards from Vault Health, Belle Artificial Intelligence, Swan AI Studios, Mila Health, Alkermes, Genomind, Takeda, Circular Genomics, and Psy Therapeutics; holding equity in Circular Genomics, Psy Therapeutics, and Vault Health; and being an associate editor for JAMA Network Open outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trust in Physicians and Hospitals Over Time, Stratified by Gender, Race and Ethnicity, and Age
Gray-shaded area spans surveys included in cross-sectional regression models. aOther race and ethnicity refers to individuals who indicated Native American, Pacific Islander, or “Other” from a survey checklist.
Figure 2.
Figure 2.. Association Between Individual Sociodemographic Features and Trust in Physicians and Hospitals in Ordinal Regression Models in Spring and Summer 2023 (N = 50 355)
OR indicates odds ratio. aOther race and ethnicity refers to individuals who indicated Native American, Pacific Islander, or “Other” from a survey checklist.
Figure 3.
Figure 3.. Association Between Trust in Physicians and Hospitals and SARS-CoV-2 Vaccination Status in Spring and Summer 2023, Adjusted for Sociodemographic Features
NA indicates not applicable; OR, odds ratio. aOther race and ethnicity refers to individuals who indicated Native American, Pacific Islander, or “Other” from a survey checklist.
Figure 4.
Figure 4.. Association Between Trust in Physicians and Hospitals at Prior Survey Among Those Who Were Not Vaccinated and Likelihood of Becoming Vaccinated Against SARS-CoV-2 at Current Survey Wave, Adjusted for Sociodemographic Features
Odds ratios (ORs) for vaccination associated with trust in physicians and hospitals at prior wave.
See this image and copyright information in PMC

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