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Black babies are less likely to die when cared for by black doctors, US study finds

BMJ 2020; 370 doi: (Published 21 August 2020) Cite this as: BMJ 2020;370:m3315
  1. Elisabeth Mahase
  1. The BMJ

Black newborn babies who are cared for by black doctors are more likely to survive than those cared for by white doctors, a US study has found.1

Researchers analysed 1.8 million hospital births in Florida from 1992 to 2015 and found that deaths were fewer by 257 in 100 000 among black newborns under the care of black doctors, when compared with care by white doctors. The US Centers for Disease Control and Prevention had reported last year that, in 2017, the infant mortality rate among black babies (10.97) was more than double that of white babies (4.67).2

Without controls, the researchers found that the raw mortality rate was not statistically different among white newborns under the care of white physicians (290 in 100 000) or black physicians (280 in 100 000).

However, under the care of white physicians, the black newborn mortality rate was estimated at 894 in 100 000 births. Under the care of black physicians this mortality rate was estimated at 390 in 100 000 births.

After applying a model that controlled for factors such as insurance and common comorbidities, the researchers found that black newborns had 430 more fatalities in 100 000 births than white newborns when under the care of white doctors. Under the care of black doctors this difference dropped by 257 in 100 000 deaths (58%).

Disproportionately white workforce

The paper, published in the Proceedings of the National Academy of Sciences of the United States of America,1 said, “Findings suggest that when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with White infants, is halved. Strikingly, these effects appear to manifest more strongly in more complicated cases, and when hospitals deliver more Black newborns.”

The researchers said that it would be understandable for pregnant women expecting to give birth to a black baby to seek care from a black doctor; however, owing to the disproportionately white workforce there were too few black physicians to service the entire population.

They also highlighted “the foundational concern of resolving the disparities in care offered by White physicians,” adding, “Finally, it is important to note that physician performance varies widely among physicians of both races, suggesting that exclusively selecting on physician race is not an effective solution to mortality concerns.

“These results underscore the need for research into drivers of differences between high and low performing physicians, and why Black physicians systemically outperform their colleagues when caring for Black newborns.”

The authors noted some limitations of the study, including that they were unable to observe the “mechanism that is driving the observed result, or the selection process of the physician.”


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