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Analysis

Research: Black Newborns Die Less Often With Black Doctors Than White Doctors

By Christopher Cheney  
   September 01, 2020

More research is needed to determine why the disparity in black newborn mortality exists.

Black newborns have a significantly higher mortality rate if their attending physicians are white rather than black, recent research indicates.

In the 2018 America's Health Rankings Annual Report, the United States ranked No. 33 out of 36 Organization for Economic Co-operation and Development (OECD) countries for infant mortality. In 2018, the U.S. infant mortality rate was 5.9 deaths per 1,000 live births, and the average infant mortality rate in all OECD countries was 3.9 deaths per 1,000 live births.

The recent research examined 1.8 million hospital births in Florida from 1992 to 2015. The study includes several key data points.

  • When black neonates are cared for by black physicians as opposed to white physicians, their in-hospital death rate is a third lower
     
  • This disparity manifests more strongly in more complicated cases and when hospitals deliver more black babies
     
  • The extent of the mortality rate reduction when black physicians care for black babies would correspond to preventing the in-hospital deaths of about 1,400 black newborns nationally each year
     
  • Physician race was not associated with an effect on the mortality rate of white neonates

The next step for researchers is to determine the mechanism that determines why black newborns have a lower mortality rate when cared for by black physicians, the lead author of the recent study told HealthLeaders.

"What this research calls for is getting into the primary setting and saying, 'What is it that these doctors, teams, and organizations are doing differently in higher and lower quality locations, and promulgating the successful behaviors from the high-quality locations to those that are struggling," said Brad Greenwood, PhD, MBA, MIT, associate professor of information systems and operations management sciences at George Mason University in Fairfax, Virginia.

"There are a lot of potential explanations—most likely it is not just one. What this work calls attention to is the fact that we need to look at locations that are performing higher and locations that are not performing as well, and figure out what the organizational team and individual behaviors are that are resulting in these disparities."

The finding that there was no significant impact on newborn mortality for white babies based on the race of the attending physician may be related to medical training in the United States, Greenwood said.

"Most medical training and most knowledge generation happens with white patients. So, you have a situation where the knowledge generation is happening with white patients—doctors are educated specifically with the presentations of white patients."

The recent study should not be interpreted as calling for black newborns to only have black physicians, he said. "This perspective calls for creating some type of Jim Crow medical system, which is exactly the wrong interpretation. … The important question is what is driving this disparity. What are black doctors doing differently than their white colleagues? That might come down to the individual level, it could come down to the team level, or it could come down to the organizational level."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

The United States has a higher infant mortality rate than most other countries in the Organization for Economic Co-operation and Development.

When black neonates are cared for by black physicians as opposed to white physicians, their in-hospital death rate is a third lower, recent research shows.

The extent of the mortality rate reduction when black physicians care for black babies would correspond to preventing the in-hospital deaths of about 1,400 black newborns nationally each year, according to the research.

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