Exploring Physician Race Affecting the Health of Black Babies

New research is casting doubt on the high-profile conclusion of the first major study showing that physician race affects health outcomes.

In August 2020, a study published in the Proceedings of the National Academies of Science made headlines with the finding that Black babies were half as likely to survive their first birthday if they were cared for by white doctors instead of Black ones.

But a new analysis in the same journal refutes that result and shows that the survival difference observed in the original study was almost entirely due to very low birth weight infants; the race of the doctor had no statistically significant effect on the mortality rates of the babies they cared for.

While other studies have shown that Black patients are more likely to follow medication guidelines and get cancer screenings and vaccinations when Black doctors request them, and a 2023 study found that people of all races in counties with at least one Black doctor lived longer. , the 2020 paper attracted widespread attention.

The study, released shortly after the death of George Floyd, received widespread attention from many groups who said it showed the urgent need to diversify the nation’s physician workforce. Only 5.2% of American physicians are black. The study was cited by Supreme Court Justice Ketanji Brown Jackson in her 2023 dissent in the widely watched case Students for Fair Admissions v. Harvard, which severely limited the use of affirmative action in college admissions.

Robert VerBruggen, co-author of the new study and fellow at the Manhattan Institute, a right-wing think tank, said he was initially skeptical about the study when he read a CNN article about it. But when he saw how extensive the paper was and how many variables it contained, he “didn’t know how to explain the findings.”

The 2020 study, which includes the 65 most common causes of infant mortality as well as factors such as insurance status and the number of very sick babies a hospital treats, has been described as “meticulous” and “meticulous” even by critics.

Verbruggen said he decided to take a closer look at the investigation after it resurfaced in the Supreme Court ruling. The new analysis included one variable that the original study did not: very low birth weight (babies weighing less than 3.3 pounds). Such babies are rare – only 1.2% of white babies and 3.3% of black babies are born this small – but are extremely small. vulnerable and have the least chance of survival.

“That’s where the death rates really skyrocket,” VerBruggen said. “This is an extremely strong predictor.”

The new study found that very low birth weight babies were both more likely to be black and cared for by white doctors, which explains much of the original finding that doctor race played a role in baby survival, he said in an interview with STAT. It was easy to understand why the factor wasn’t originally included, VerBruggen said, because birth weight isn’t easy to extract from the data. The original authors had used some measures of low birth weight and preterm birth, but did not focus on the very lowest weights.

The sickest babies, the new study finds, are most likely to be treated in neonatal intensive care units (NICUs), which are largely staffed by white doctors. Only 3.8% of the nation’s neonatologists are black. The study also noted that it is not fair to attribute the outcomes of babies in NICUs to a single physician, as those babies are cared for by large (and presumably multiracial) teams who can ignore any implicit or explicit bias associated with a single doctor could exist, would be pushed aside. .

The new study found that doctors’ race still appeared to play a role in baby survival, but this was not statistically significant. “You can’t say the effect is zero, but it is much smaller than what they had,” VerBruggen said. He also praised the lead author of the original study for being open to sharing the data and guiding him through the original analysis.

That researcher, Ben Greenwood, said he was happy to share his data. “We encouraged them to study this because it’s so important,” said Greenwood, professor of business administration at George Mason University’s Costello College of Business. “I don’t think it helps to be defensive about your work.”

Greenwood told STAT that he thought the new analysis still showed that doctors’ race played a role in infant mortality, even if it was smaller than the effect his study showed, and that the conflicting findings highlight the need for more research . Further research using different statistical models or considering different variables could lead to yet other conclusions about the complex role a doctor’s race could play, he said.

“If the real goal is to reduce infant mortality, we need to make sure people keep doing it,” he said.

Greenwood said he believed his research has been more heavily scrutinized than other topics in health research because issues like race are so politically divisive. He added that he was not happy with how the study has been used by the right or left, including people who interpreted the finding to conclude that some white doctors are racist.

“The first thing we said in every interview is don’t select your doctor based on race. There are great doctors and bad doctors of any race,” he said. “We also said that you should not make a policy on this.”

VerBruggen is very open that politics – and the role the 2020 study could play in establishing policy – ​​was a driving factor in making a new analysis. The Manhattan Institute is a “free-market, right-wing” think tank, he said. VerBruggen is not an academic. He is a journalist, but says he taught himself how to use statistical analysis software. For the new research, he collaborated with George J. Borjas, an economist from Harvard.

Borjas, a Cuban-American who focuses on immigration, has been involved in several research controversies, including his supervision of a 2009 Harvard dissertation that argued that Latino immigrants in the U.S. are and will remain less intelligent than “native whites” . His work showing that Cuban immigration to Florida lowered wages in the state was frequently cited by the Trump White House and politicians seeking to limit immigration, although it has been largely refuted by other economists.

Politics aside, Verbruggen said this new study has shown that future research into infant mortality should include very low birth weight as a factor and also examine hospital effects – some hospitals have more technology that could save the lives of premature babies. “The racial gap (in infant mortality) is worth studying,” he said.

Black babies are twice as likely to die in their first year, compared to white babies. Understanding which factors might curb these numbers, and which might not, are crucial topics for future research, says Ted Joyce, an economist at Baruch College, in a commentary accompanying the new paper.

Black babies are also three times more likely to be born with very low birth weight than white babies, Joyce noted. Figures shown in other research are clearly linked to socio-economic status and have not changed significantly over the past thirty years.

STAT’s coverage of health inequalities is supported by a Commonwealth Fund grant. Our financial supporters are not involved in decisions about our journalism.