Does skepticism towards medical care predict mortality?

OBJECTIVES. Attitudes towards medical care have a strong effect on utilizat ion and outcomes. However, there has been little attention to the impact on outcomes of doubts about the value of medical care. This study examines th e impact of skepticism toward medical care on mortality using data from the 1987 National Medical Expenditure Survey (NMES). METHODS. A nationally representative sample from the United States comprisi ng 18,240 persons (greater than or equal to 25 years) were surveyed. Skepti cism was measured through an 8-item scale. Mortality at 5-year follow-up wa s ascertained through the National Death Index. RESULTS. In a proportional hazards survival analysis of 5-year mortality th at controlled for age, sex, race, education, income, marital status, morbid ity, and health status, skepticism toward medical care independently predic ted subsequent mortality. That risk was attenuated after adjustment for hea lth behaviors but not after adjustment for health insurance status. CONCLUSION. Medical skepticism may be a risk factor for early death. That e ffect may be mediated through higher rates of unhealthy behavior among the medically skeptical. Further studies using more reliable measures are neede d.