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

IMPORTANCE Trustinphysiciansandhospitalshasbeenassociatedwithachievingpublichealth goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust.

OBJECTIVE TocharacterizechangesinUSadults’trustinphysiciansandhospitalsoverthecourse of the COVID-19 pandemic and the association between this trust and health-related behaviors.

DESIGN,SETTING,ANDPARTICIPANTS Thissurveystudyusesdatafrom24wavesofa 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.

MAINOUTCOMEANDMEASURE Self-reportoftrustinphysiciansandhospitals;self-reportof 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 Thecombineddataincluded582634responsesacross24surveywaves,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).

CONCLUSIONSANDRELEVANCE ThissurveystudyofUSadultssuggeststhattrustinphysicians 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.