Because of a host of socioeconomic factors in the United States, Black newborns are more than twice as likely to die in their first year compared with White infants. However, researchers found that Black newborns are less likely to die if they are cared for by a Black physician vs a White physician — excess Black infant mortality rates are halved when there is racial concordance.
Lead author Brad N. Greenwood, PhD, MBA, and colleagues from George Mason University, Fairfax, Virginia, investigated disparities and inequities in clinical outcomes for newborns using data from Florida’s Agency for Healthcare Administration (AHCA), and published their findings in Proceedings of the National Academy of Sciences of the United States of America.1 Based on AHCA data, they concluded that racial concordance between newborn and physician improves Black newborn survival for at least 2 main reasons:
- Adult spontaneous racial bias is of equal strength when directed at either children or adults; therefore, Black newborns may receive care from a biased physician.
- Black newborns are at greater risk for infant mortality because of social, economic, and medical issues that a Black physician may be more familiar with as a member of the same community compared with a White physician.
In a simple model analysis of hospital births in Florida between 1992 and 2015, researchers found that the in-hospital mortality rate of Black newborns was triple that of White newborns when under the care of White physicians.
Per 100,000 births under the care of White physicians, there were 430 more fatalities among Black newborns than White newborns. By contrast, per 100,000 births under the care of Black physicians, there were 173 more deaths among Black newborns vs White newborns, a 58% reduction in racial excess mortality difference.
Researchers did not observe a statistically significant difference in outcomes for White newborns when they were cared for by a White physician vs a Black physician. There was also no observed effect of racial concordance on mortality for birthing mothers.
The association between Black newborns being treated by Black physicians and improved outcomes was strongest in medically complicated cases, and at hospitals where a large number of Black newborns are delivered.
“Empirically, this study provides evidence that the Black–White newborn mortality gap is smaller when Black doctors provide care for Black newborns than when White doctors do — lending support to research that examines the importance of racial concordance in addressing healthcare disparities,” the study authors stated.
This study is inherently limited by the lack of observation of the entire patient care team’s composition; the race of residents, nursing staff, and other providers was not recorded. In addition, this study only included newborns delivered in a hospital, eliminating babies delivered in home births.
The study authors called for further study of Black infant mortality inequity and its origins, as well as how healthcare workers can work together to create better birth outcomes for all newborns.
Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A. 2020;117(35):21194-21200. doi:10.1073/pnas.1913405117