Association of COVID-19 outcomes with measures of institutional and interpersonal trust: an ecological analysis using national data from 61 countries

Abstract

Despite the importance of human behavior in containing a disease outbreak, formal quantitative analyses examining the relationship between measures of trust and COVID-19 outcomes remain limited. We use data from Wave 7 (2017-2022) of the World Values Survey to assess the country-level relationship between trust and COVID-19 outcomes across 61 countries via clustering and regression. After adjusting for country-level confounders, our findings indicate that countries with low trust have significantly greater numbers of COVID-19 deaths (1200.6 more COVID-19 deaths per million, 95% CI [510.92, 1890.3]), significantly greater excess death (2289.1 more excess deaths per million, 95% CI [971.1, 3607.2]), and a lower vaccination rate (16.6 fewer people vaccinated per 100, 95% CI [-27.7, -5.6]) than high trust countries, suggesting a tangible impact of trust on country-level COVID-19 outcomes. We discuss differences between interpersonal and institutional trust and advocate for incorporating trust in disease modeling to better predict country-level outcomes.

Fig. 1

A flow chart describing the data sources used for analysis, our study objective, our various study methodologies, and our analytical outputs.

Fig. 2

Visualization of the three clusters identified by k-means (left) and GMM (right) on the first two principal components of the 23 trust items.

Fig. 3

The ordinal and nominal response options for our survey questions of interest, alongside an example of this data for the United States and the question “How much confidence do you have in the government?”