Race and Medicine

Race and Medicine

Disclosures: The authors report no relevant financial disclosures.
August 21, 2020
2 min read

Black newborns more likely to die under care of white physicians

Disclosures: The authors report no relevant financial disclosures.
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Under the care of white physicians, Black newborns are three times more likely to die than white newborns, according to a study published in Proceedings of the National Academy of Sciences of the United States of America.

Researchers found that when Black physicians cared for Black newborns, the mortality rate for the newborns declined by up to 58%.

Source: Adobe Stock
Under the care of white physicians, Black newborns are three times more likely to die than white newborns. Source: Adobe Stock

Brad N. Greenwood, PhD, associate professor of information systems and operations management at George Mason University in Fairfax, Virginia, and colleagues reviewed 1.8 million hospital births in Florida between 1992 and 2015 and found that, under the care of a white physician, the white newborn mortality rate was 290 per 100,000 births compared with a rate of 894 per 100,000 births for Black newborns.

Brad N. Greenwood

“There is significant evidence of spontaneous racial bias that certainly could be a factor at play here. Although I have no reason to believe — and I don't think anybody on the team would say — this is a malicious bias on the part of physicians,” Greenwood told Healio.

“I think you have [a lack of] access to care, which is a systemic problem,” Greenwood said. “So, you may not have women of color being able to access their preferred providers. The effect is certainly stronger in hospitals where more Black newborns are being delivered, which could suggest that this is an institutional problem to some extent.”

The researchers analyzed data from both mother and newborn, including information on race, comorbidities, outcomes and the hospital where they were treated.

Information on the attending physician also was available. Information regarding the physician’s race was not available and was obtained by searching publicly released photos.

From the sample data, the raw mortality rate among 1.35 million white newborns was 289 per 1,000 births compared with 784 per 100,000 deaths among 460,000 Black newborns. Greenwood and colleagues applied the sample mortality rate to the current number of Black newborns born in the United States, which showed that roughly 4,400 Black newborns die annually. If Black newborns had the same mortality rate as whites, it would fall by about 2,800 deaths annually.

Under the care of Black physicians, the mortality rate among Black newborns was 173 per 100,000 above white newborns, a difference of 257 deaths per 100,000 births — a 58% reduction in racial mortality differences. Another estimate based on modeling showed a 39% reduction.

According to Greenwood, Black patients comprise 13% of the U.S. population, whereas only 5% of U.S. physicians are Black, indicating a structural problem.

“In reality, babies are dying. In the richest society on Earth, the fact that we are 30th out of 33 [Organization for Economic Cooperation and Development] countries in infant mortality is unacceptable,” Greenwood said. “I think what we're hoping is that this [study] calls attention to an issue that people can work positively to try and resolve, instead of just pushing and making people more entrenched in their viewpoints.”