Factors Associated With Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US.
Factors Associated With Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US.
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DOI：
10.1001/jamanetworkopen.2021.11629
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发表时间：
2021-05-03
影响因子：
13.8
通讯作者：
Marks B
中科院分区：
文献类型：
--
作者：
Thompson HS;Manning M;Mitchell J;Kim S;Harper FWK;Cresswell S;Johns K;Pal S;Dowe B;Tariq M;Sayed N;Saigh LM;Rutledge L;Lipscomb C;Lilly JY;Gustine H;Sanders A;Landry M;Marks B
这项针对2020年6月至12月期间居住在密歇根州的成年人的调查研究考察了种族/族裔、种族/族裔群体内的医疗不信任以及参与COVID-19疫苗试验或接受COVID-19疫苗的意愿之间的关联。在美国，种族/民族与拒绝COVID-19疫苗试验参与和疫苗接种之间是否存在关联，基于种族/民族的医学不信任是否介导了这种关联？在这项对密歇根州1835名成年人的调查研究中，黑人参与者报告说，在接受调查的种族/族裔群体中，对医疗的不信任程度最高。对路径模型的分析显示，黑人参与者对COVID-19疫苗试验和摄取的排斥反应明显更大，这部分是由医疗不信任介导的。研究结果表明，基于种族/族裔群体的医疗不信任可能部分解释了黑人种族/族裔与拒绝COVID-19疫苗试验参与和摄取之间的关联，可能为在该群体中促进COVID-19疫苗接种的社会和文化响应努力提供信息。COVID-19对美国的影响深远且具有破坏性，尤其是对黑人人口。疫苗接种是控制社区传播的关键部分，但疫苗接受程度各不相同，一些研究报告称，美国黑人比其他种族/族裔群体更不愿意接种疫苗。由种族主义经历所引起的医疗不信任可能与这种较低的意愿有关。研究种族/民族与拒绝COVID-19疫苗试验参与和疫苗接种之间的关联，并调查基于种族/民族的医学不信任是否是这种关联的潜在中介。这项横断面调查研究于2020年6月至12月进行，使用了1835名居住在密歇根州的18岁或以上成年人的便利样本。参与者通过社区组织和医院学术网络招募。单独的项目评估受访者是否同意参加一项研究，以测试COVID-19疫苗或接受COVID-19疫苗。参与者还完成了基于群体的医疗不信任量表的怀疑分量表。在1835名参与者中，1455名（79%）为女性，361名（20%）为男性，19名（1%）为其他性别。平均（SD）年龄为49.4（17.9）岁，394名参与者（21%）被确定为黑人。总体而言，1376名参与者（75%）报告参与疫苗试验的意愿较低，945名（52%）报告接种疫苗的意愿较低。与其他种族/民族群体（总样本的平均值[SD]为1.83 [0.91]）相比，黑人参与者报告了最高的医疗不信任评分（平均值[SD]为2.35 [0.96]）。路径模型分析显示，与总体平均排斥相比，黑人参与者的疫苗试验和疫苗摄取排斥显著更大（疫苗试验：B [SE]，0.51 [0.08];疫苗摄取：B [SE]，0.51 [0.08];均P <0.001）。这种联系部分是由于黑人参与者对医学的不信任造成的（疫苗试验：B [SE]，0.04 [0.01]; P =.003;疫苗摄取：B [SE]，0.07 [0.02]; P <.001）和白色参与者（疫苗试验：B [SE]，-0.06 [0.02]; P =.001;疫苗摄取：B [SE]，-0.10 [0.02]; P <.001）。在这项针对美国成年人的调查研究中，基于种族/族裔群体的医疗不信任部分介导了黑人个体与COVID-19疫苗试验参与和实际接种接受率低之间的关联。研究结果表明，卫生保健和其他部门之间建立信任和促进疫苗接种的伙伴关系可能会受益于社会和文化响应战略，承认和解决种族/民族卫生保健差距和历史和当代的种族主义经验。
This survey study of adults residing in Michigan during June to December 2020 examines associations between race/ethnicity, medical mistrust within racial/ethnic groups, and willingness to participate in COVID-19 vaccine trials or to receive a COVID-19 vaccine. Is there an association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake in the US, and does racial/ethnic group–based medical mistrust mediate this association? In this survey study of 1835 adults in Michigan, Black participants reported the greatest medical mistrust among the racial/ethnic groups surveyed. Analysis of path models revealed significantly greater COVID-19 vaccine trial and uptake rejection among Black participants, which was partially mediated by medical mistrust. The findings suggest that racial/ethnic group–based medical mistrust may partially explain the association between Black race/ethnicity and rejection of COVID-19 vaccine trial participation and uptake, potentially informing socially and culturally responsive efforts to promote COVID-19 vaccination in this group. The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group–based medical mistrust is a potential mediator of this association. This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], −0.06 [0.02]; P = .001; vaccine uptake: B [SE], −0.10 [0.02]; P < .001). In this survey study of US adults, racial/ethnic group–based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.
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