Perception of Racism Explains the Difference Between Blacks' and Whites' Level of Healthcare Trust

Objective: To test the hypothesis that the level of healthcare trust does not differ between Blacks and Whites.

Design: Cross-sectional telephone-based survey.

Methods: This study recruited low-income residents of Miami-Dade and Duval counties in Florida by using random-digit dialing (RDD). One thousand and five residents participated; however, analyses were limited to Black (n=550) or White (n=374) respondents. Trained interviewers used a structured questionnaire to obtain information about respondent demographics, trust in health care, perception of racism, and access to care.

Results: Black respondents included fewer males (P=.0146) and younger subjects (P < or = .05); otherwise, they were similar to White respondents. Compared to Duval County respondents, Miami-Dade respondents were younger (< or = .05), richer (< or = .05), and mostly males (P=.0355). Blacks perceived more racism than did Whites (P<.0001). Healthcare trust differed by race and respondents' county (P<.0001). The proportion of variance in healthcare trust explained (R2) by race was 2%. Introducing perception of racism into the model eliminated differences in trust between White and Black respondents. Overall, the model explaining healthcare trust accounted for 21.2% of the variance in trust; the model adjusted for respondents' county, demographics, access to care, and liking treatment during routine appointment.

Conclusion: This study observed that perception of racism accounted for the residual differences in healthcare trust between Whites and Blacks; therefore, healthcare distrust may not be an attribute of Blacks. Respondents' experience with the healthcare system accounted for most of the difference in trust.