title: Does skepticism towards medical care predict mortality?
abstract: OBJECTIVE
  Attitudes towards medical care have a strong effect on utilization and outcomes. However, there has been little attention to the impact on outcomes of doubts about the value of medical care. This study examines the impact of skepticism toward medical care on mortality using data from the 1987 National Medical Expenditure Survey (NMES).
  
  
  METHODS
  A nationally representative sample from the United States comprising 18,240 persons (> or = 25 years) were surveyed. Skepticism was measured through an 8-item scale. Mortality at 5-year follow-up was ascertained through the National Death Index.
  
  
  RESULTS
  In a proportional hazards survival analysis of 5-year mortality that controlled for age, sex, race, education, income, marital status, morbidity, and health status, skepticism toward medical care independently predicted subsequent mortality. That risk was attenuated after adjustment for health behaviors but not after adjustment for health insurance status.
  
  
  CONCLUSIONS
  Medical skepticism may be a risk factor for early death. That effect may be mediated through higher rates of unhealthy behavior among the medically skeptical. Further studies using more reliable measures are needed.
authors.affiliation: Primary Care Institute, and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY, USA. kfiscella@highland.rochester.edu
authors.forename: K
authors.initials: K
authors.lastname: Fiscella
authors.forename: P
authors.initials: P
authors.lastname: Franks
authors.forename: C M
authors.initials: CM
authors.lastname: Clancy
authors.forename: M P
authors.initials: MP
authors.lastname: Doescher
authors.forename: J S
authors.initials: JS
authors.lastname: Banthin
mesh_terms: D001294:Attitude to Health; D015331:Cohort Studies; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D009026:Mortality; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States