Black newborns in the US nearly thrice more likely to die in hospital under White physicians' care: Study
When cared for by White doctors, Black newborns are approximately three times more likely to die in the hospital than White newborns in the US, reveals a startling new study. However, when Black physicians cared for Black newborns, the death rate of Black newborns declined between 39% and 58%. This phenomenon was especially evident in cases of challenging births and in hospitals that delivered relatively more Black babies, say authors from George Mason University, Fairfax, University of Minnesota-Twin Cities, Minneapolis, and Harvard University, Boston.
According to the researchers, however, a physician’s race had little association with the death rate of White newborns. The findings suggest that Black physicians outperform their White colleagues when caring for Black newborns, they add.
“The big takeaways of the paper are that the Black-White newborn mortality gap is smaller when Black doctors provide care for Black newborns, and that gap reduction occurs in more medically complex cases. The quick interpretation that a lot of people may come to, and we want to caution against, is that families giving birth to a Black baby should exclusively seek care from a Black physician. There are a couple of problems with this conclusion,” the study’s corresponding author Brad N Greenwood from the School of Business at George Mason University told MEA WorldWide (MEAWW).
He explains: “First, pragmatically, the disproportionately White physician workforce makes this untenable because there are not enough Black physicians to service the entire population. Second, it avoids the actual problem, because it doesn’t resolve the foundational concern of disparities in care, that is, if every family did this the disparities in care wouldn’t go away. Finally, this isn’t a great selection criterion, because physician performance varies widely among physicians of both races. As a result, exclusively selecting (doctors based) on physician race is not an effective solution to mortality concerns.”
A large body of work highlights disparities in survival rates across Black and White newborns during childbirth. “However, whether patient-physician racial concordance improves survival outcomes for Black infants remains unclear,” says the research team. To determine the relationship between newborn death risk and the attending physician’s race, they reviewed nearly 2 million records of hospital births in Florida that occurred between 1992 and 2015. The authors also retrieved the names of the physicians in charge of the newborns’ care and determined each physician’s race based on publicly searchable photographs.
The analysis reveals that Black infants experience “inferior health outcomes” regardless of who is treating them. However, the researchers found that when Black newborns are cared for by Black doctors, the “death penalty” they suffer as compared with White infants, is halved.
“Under the care of White physicians, Black newborns experience triple the in-hospital mortality rate of White infants. Under the care of White physicians, Black newborns experience 430 more fatalities per 100,000 births than White newborns. Under the care of Black physicians, the mortality penalty for Black newborns is only 173 fatalities per 100,000 births above White newborns, a difference of 257 deaths per 100,000 births, and a 58% reduction in the racial mortality difference,” write authors in the study published in the Proceedings of the National Academy of Sciences (PNAS).
They add, “Clinical penalties for Black newborns treated by Black physicians are halved compared with the penalties Black newborns experience when cared for by White physicians. Strikingly, these effects appear to manifest more strongly in more complicated cases, and when hospitals deliver more Black newborns. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.”
So what can be done? Greenwood says that more research is needed to understand the precise dynamics behind the findings. “Specifically (this includes research on) whether physician race proxies for differences in physician practice behavior, and if so, which practices, and what actions can be taken by policymakers, administrators, and physicians to ensure that all newborns receive optimal care. The work, in my mind, is a starting point. It identifies an issue that is a real problem and provides some paths forward. But a lot of work remains to understand the issue in its entirety,” Greenwood told MEAWW.
According to Greenwood, the work also underscores the need to continue the diversification of the medical workforce. “In as much as research suggests stereotyping and implicit bias contribute to racial disparities in health outcomes, I think the work also highlights the need for hospitals and other care organizations to invest in efforts to reduce such biases and explore their connection to institutional racism,” he says. However, the author emphasizes that the effort does not simply rest on the shoulders of hospital administrators. “Reducing racial disparities in newborn mortality also requires raising awareness among physicians, nurses, and other healthcare actors about the prevalence of these disparities, furthering diversity initiatives and revisiting the organizational routines in low performing hospitals to determine why these effects persist,” Greenwood told MEAWW.