• Celeste Campos-Castillo.
• Department of Sociology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA. Electronic address: camposca@uwm.edu.
• J Natl Med Assoc. 2019 Aug 1; 111 (4): 393-406.

BackgroundResearch on skin color inequality is growing, but few studies examine the health care context.ObjectiveThis study explored associations between black and white respondents' skin color and their trust in physicians using the 2012 General Social Survey (n = 1026), which is a national survey of U.S. adults.MethodsBivariate and multivariable analyses examined how trust in physician is related to skin color and race. Five items measuring trust were aggregated using three different methods (summation, averaging, scaling) and disaggregated (estimated one item at a time) in analyses.ResultsAcross the three aggregation methods, neither skin color nor race were independently related to trust. For the disaggregation method, darker skin was associated with less trust that physicians to discuss all treatment options among white females, black females, and black males. Among white males, darker skin increased this trust.ConclusionAggregating trust items and relying on only self-reported race may produce false conclusions about a lack of racial differences. Skin color is associated with complex concerns about physicians withholding treatment, which may reduce shared decision-making and treatment adherence. Skin color should be tracked to better capture health care experiences and population health.Copyright © 2019 National Medical Association. Published by Elsevier Inc. All rights reserved.

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