It is shown that inflationary cosmology may be used to test the statistical predictions of quantum theory at very short distances. Hidden-variables theories, such as the pilot-wave theory of de Broglie and Bohm, allow the existence of vacuum states with non-standard field fluctuations (quantum non-equilibrium). It is shown that such non-equilibrium vacua lead to statistical anomalies, such as a breaking of scale invariance for the primordial power spectrum. The results depend only weakly on the details of the de Broglie-Bohm dynamics. Recent observations of the cosmic microwave background are used to set limits on violations of quantum theory in the early universe.