Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults
Level 4 - case-series / case-control
Repeated cross-sectional nonprobability survey study (graded by design analogy)
OpenAlex W4401170523 · doi:10.1001/jamanetworkopen.2024.24984
What was done
Analyzed 24 waves of a nonprobability internet survey conducted between April 1, 2020, and January 31, 2024, across all 50 US states. The sample included 443,455 unique respondents aged 18 years or older (582,634 total responses) with state-level quota sampling for age, gender, and race/ethnicity. Survey-weighted regression models evaluated changes in self-reported trust in physicians and hospitals over time and assessed associations between trust, sociodemographic factors (controlling for partisanship), and self-reported SARS-CoV-2 and influenza vaccination.
What was found
The proportion of US adults reporting "a lot of trust" in physicians and hospitals declined from 71.5% (95% CI, 70.7%-72.2%) in April 2020 to 40.1% (95% CI, 39.4%-40.7%) in January 2024. Lower trust in spring/summer 2023 was independently associated with age 25 to 64 years, female gender, lower education, lower income, Black race, and rural residence. Higher trust was strongly associated with increased likelihood of SARS-CoV-2 vaccination (adjusted OR, 4.94; 95% CI, 4.21-5.80), influenza vaccination (adjusted OR, 5.09; 95% CI, 3.93-6.59), and SARS-CoV-2 booster receipt (adjusted OR, 3.62; 95% CI, 2.99-4.38).
Why it matters
This study documents a sharp, nationwide erosion of public trust in medical professionals and institutions during the COVID-19 pandemic and shows that this decline corresponds to substantially lower uptake of preventive vaccines.
Limits
The study used a nonprobability online survey panel, which may introduce selection bias despite weighting and quota sampling. All measures—including trust and vaccination status—relied on self-report without clinical verification. Observational associations cannot prove that declining trust directly caused lower vaccination rates.
Cited by
- supports Public trust in medicine dropped from around 70% before the COVID-19 pandemic to around 40% post-pandemic.