title: Distrust of the health care system and self-reported health in the United States.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Random-digit-dialing telephone survey.
  
  
  METHODS
  Nine hundred and sixty-one adult residents of the continental U.S.
  
  
  METHODS
  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.
authors: Department of Medicine, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA. karmstro@mail.med.upenn.edu
authors: Katrina
authors: K
authors: Armstrong
authors: Abigail
authors: A
authors: Rose
authors: Nikki
authors: N
authors: Peters
authors: Judith A
authors: JA
authors: Long
authors: Suzanne
authors: S
authors: McMurphy
authors: Judy A
authors: JA
authors: Shea