COVID-19 Pandemic
Medical mistrust and COVID-19 vaccine attitudes and behavior: Findings from a population-based cohort study in Michigan Soomin Ryu* Soomin Ryu Akash Patel Kristi L. Allgood Delvon T. Mattingly Jana L. Hirschtick Robert Orellana Nancy L. Fleischer
Background: 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.
Methods: We examined associations of self-reported measures of medical mistrust with COVID-19 vaccine attitudes at baseline and uptake of vaccination at follow-up using a population-based sample of adults in Michigan with PCR-confirmed SARS-CoV-2 infection between March 2020 and May 2022. 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. We defined 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 (n=3,863), (2) modified Poisson regression with robust standard errors to estimate prospective associations between MMI and vaccination status (n=3,502), and (3) effect-modification and stratified analysis by race and ethnicity.
Results: The mean MMI score was 1.89 (range: 1−4), where a higher score indicated a higher level of medical mistrust. The mean vaccine attitudes score was 3.45 (range: 1−5), with a higher score indicating a higher level of positive vaccine attitudes. At follow-up, the prevalence of receiving a COVID-19 vaccine was 77.5%. Higher MMI was associated with less positive vaccine attitudes at baseline (b= −0.63, SE= 0.036), and lower COVID-19 vaccine uptake at follow-up (aPR: 0.85, 95% CI: 0.82–0.88). Interestingly, these associations were more pronounced among non-Hispanic White individuals than among racial and ethnic minoritized individuals.
Conclusions: Understanding drivers of medical mistrust may help rebuild public trust in healthcare systems needed to promote vaccine uptake and improve public health.