Black Newborns Less Likely to Die When the Treating Physician Is Also Black

By Linda Carroll

August 20, 2020

(Reuters Health) - While research has shown that Black newborns in the U.S. die at three times the rate of white newborns, a new study suggests that those numbers might improve when the race of the physician is concordant with the child's.

Based on data from 1.8 million births between 1992 and 2015, researchers found the in-hospital death rate among Black newborns was one third lower when these babies were treated by a Black physician, rather than a white one, according to the results published in the Proceedings of the National Academy of Sciences.

The research doesn't hold the key to why concordance might be beneficial to Black infants, said study coauthor Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity at the University of Minnesota-Twin Cites School of Public Health, in Minneapolis.

"That's the million-dollar question," Hardeman said. "What we know from previous research is that there are issues around racism and implicit bias and that when physicians are short on time or in stressful situations, they are much more likely to rely on implicit biases."

To take a closer look at whether patient-physician concordance could make a difference in Black newborn survival, Hardeman and her colleagues modeled data from the State of Florida's Agency for Healthcare Administration, which provides a census of patients admitted to Florida hospitals.

Those data include detailed information on both the mother and the newborn, including race; comorbidities; outcomes; and the name, specialty certifications, and date of licensure of the treating physician. While the database did not include the physician's race, the researchers determined that from publicly available photos.

For their analysis, the researchers only included data on Black and white newborns and Black and white physicians. Overall, they found the raw mortality rate for white newborns was 289 per 100,000 births, while the raw mortality rate for Black newborns was 784 per 100,000 births.

When the researchers analyzed newborn death rates by race of treating physician, they found that under the care of a white physician, Black newborns experienced 430 more fatalities per 100,000 births than white newborns. Under the care of Black physicians there was a big difference: there were 173 more fatalities per 100,000 births among Black newborns compared to white newborns. That's a difference of 257 deaths per 100,000, the authors note.

When the researchers looked specifically at white newborns treated by white physicians, they did not find a similar benefit from concordance.

Ultimately, the researchers determined that the "mortality penalty" for Black newborns is 39% lower under the care of a Black physician than under a white physician.

The new study is "really interesting," said Dr. Melissa Simon, a professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine in Chicago.

"It has created a signal that further research is needed in this area," Dr. Simon said. "The research requires replication. We in the field of health equity and racial justice hypothesize about concordance and how it might impact outcomes."

Other studies looking at racial concordance have had mixed findings, Dr. Simon said. For example, racial concordance between pregnant women and healthcare providers has not shown any benefit, she said.

"This study definitely moves the field forward," Dr. Simon said. "Why concordance might improve infant mortality would be interesting to study."

SOURCE: PNAS, online August 17, 2020.