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Katrina Armstrong, MD, MSCE, Karima L. Ravenell, MS, Suzanne McMurphy, PhD and Mary Putt, ScD

At the time of the study, Katrina Armstrong, Karima L. Ravenell, and Suzanne McMurphy were with the Department of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. Mary Putt and Katrina Armstrong were with the Department of Biostatistics and Epidemiology, University of Pennsylvania, Phialdelphia.

Correspondence: Requests for reprints should be sent to Dr Katrina Armstrong, Department of Medicine, University of Pennsylvania, 1204 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (e-mail: karmstro{at}mail.med.upenn.edu).

Objectives. We examined the racial/ethnic and geographic variation in distrust of physicians in the United States.

Methods. We obtained data from the Community Tracking Study, analyzing 20 sites where at least 5% of the population was Hispanic and 5% was Black.

Results. In univariate analyses, Blacks and Hispanics reported higher levels of physician distrust than did Whites. Multivariate analyses, however, suggested a complex interaction among sociodemographic variables, city of residence, race/ethnicity, and distrust of physician. In general, lower socioeconomic status (defined as lower income, lower education, and no health insurance) was associated with higher levels of distrust, with men generally reporting more distrust than women. But the strength of these effects was modified by race/ethnicity. We present examples of individual cities in which Blacks reported consistently higher mean levels of distrust than did Whites, consistently lower mean levels of distrust than did Whites, or a mixed relationship dependent on socioeconomic status. In the same cities, Hispanics reported either consistently higher mean levels of distrust relative to Whites or a mixed relationship.

Conclusions. Racial/ethnic differences in physician distrust are less uniform than previously hypothesized, with substantial geographic and individual variation present.

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