Latent class analysis of medical mistrust and COVID-19 vaccine hesitancy among adults in the United States just prior to FDA emergency use authorization

Using a nationally representative household sample, we sought to better understand types of medical mistrust as a driver of COVID-19 vaccine hesitancy. We used survey responses to conduct a latent class analysis to classify respondents into categories and explained this classification as a function of sociode-mographic and attitudinal variables using multinomial logistic regression models. We then estimated the probability of respondents agreeing to receive a COVID-19 vaccine conditional on their medical mistrust category. We extracted a five-class solution to represent trust. The high trust group (53.0 %) is character-ized by people who trust both their doctors and medical research. The trust in own doctor group (19.0 %) trust their own doctors but is ambiguous when it comes to trusting medical research. The high distrust group (6.3 %) neither trust their own doctor nor medical research. The undecided group (15.2 %) is char-acterized by people who agree on some dimensions and disagree on others. The no opinion group (6.2 %) did not agree nor disagree with any of the dimensions. Relative to the high trust group, those who trust their own doctors are almost 20 percentage points less likely to plan to get vaccinated (average marginal effect (AME) = 0.21, p <.001), and those who have high distrust are 24 percentage points less likely (AME =-0.24, p <.001) to report planning to get the vaccine. Results indicate that beyond sociodemo-graphic characteristics and political attitudes, people's trust archetypes on parts of the medical field sig-nificantly predict their probability of wanting to get vaccinated. Our findings suggest that efforts to combat vaccine hesitancy should focus on building capacity of trusted providers to speak with their patients and parents of their patients, to recommend COVID-19 vaccination and build a trusting relation-ship; and increase trust and confidence in medical research.(c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

Using a nationally representative household sample, the study investigated the relationship between medical mistrust and COVID-19 vaccine hesitancy. The results showed that different trust archetypes significantly predicted individuals' willingness to receive the vaccine. Efforts to combat vaccine hesitancy should focus on building trust between providers and patients, as well as increasing trust in medical research.