How Race, Poverty, Health Literacy, and Discrimination Affect the Relationship Between Medical Mistrust and Self-Rated Health over Time.

Abstract

Mistrust of the health care system is associated with underutilization of medical services and poor self-reported health, which itself is an important indicator for future morbidity and mortality. This study examines how several factors influence the association between medical mistrust and self-rated health in a middle-aged socioeconomically diverse cohort over 16 years. Participants (n = 1673) from the Health Aging in Neighborhoods of Diversity over the Life Span Study formed the sample. Information was gathered on race (African American/White), sex, poverty status, health literacy, and two measures of perceived discrimination. Linear mixed model regression was used for several models to examine the independent and combined influence of these factors on how medical mistrust is related to self-rated health over time. Poverty status exhibited the greatest influence on longitudinal self-rated health. Poverty status and health literacy did not influence the association between medical mistrust and self-rated health but perceived discrimination did. Stratified analyses by race found that White participants exhibited greater influence from medical mistrust and perceived discrimination on self-rated health than African American participants. Increasing trust, improving communication, and reducing unfair treatment across vulnerable groups is likely to improve health in middle-aged adults, but reducing overall poverty is likely to have the greatest effect.