Abstract
Background
Group-based medical mistrust is a critical yet understudied factor associated with healthcare utilization among Black, African American, Hispanic/Latino, Asian/AAPI, or Indigenous working adults. How mistrust relates to primary care (GP/PCP), urgent care/emergency room (ER), and hospital-based care, and whether these associations vary by health perceptions or insurance coverage, remains unclear.Objectives
This study examined whether higher group-based medical mistrust was associated with lower primary care use, greater urgent care/ER use, and hospitalizations, and whether health perceptions and health insurance coverage moderated these associations.Methods
A cross-sectional online survey of 282 working adults aged 25-64 who identified as Black/African American, Asian/AAPI, or another racially or ethnically minoritized group measured group-based medical mistrust, health perceptions, insurance coverage, and healthcare utilization in the prior 12 months. Multinomial logistic regression estimated relative risk ratios for GP/PCP and urgent care/ER utilization. Binary logistic regression estimated odds of ≥ 1 hospitalization. Models adjusted for sociodemographic characteristics (age, gender, race/ethnicity, employment status, education, and insurance coverage) and tested interactions between group-based medical mistrust, health perceptions, and insurance coverage.Results
Higher mistrust was significantly associated with greater urgent care/ER use and hospitalizations. Among privately insured adults, mistrust more than doubled the relative risk of 1-2 urgent/ER visits; this association was substantially weaker among publicly insured adults.Conclusions
Group-based medical mistrust was associated with greater acute care utilization but not reduced primary care use. Findings suggest mistrust may be associated with where and when healthcare is sought, underscoring the need to strengthen health systems' trustworthiness.