ROCHESTER, Minn. — Systemic institutional racism within healthcare is a fuzzy picture.
We know Black people fare worse in terms of health in the U.S., but the list of likely factors behind the problem is lengthy — enough to obscure the possibility that Black people get worse care in the hospital from white doctors.
Evidence shows Black patients tend to be more satisfied when they have a Black physician, but until now, we do not know if the reasons for this preference could translate into better health outcomes.
A study out today in the journal PNAS and conducted by researchers at the University of Minnesota's Carlson School of Management in partnership with faculty from Harvard University and George Mason University proves that not only is systemic institutional racism responsible for hundreds of preventable deaths a year, but that the problem starts at birth.
"We wanted to understand the relationship between physician race and patient outcomes," said Aaron Sojourner, an associate professor of economics at the Carlson School of Management and lead author on the study.
Looking at data from 1.8 million hospital births in Florida between 1992 and 2015, the researchers set out to see whether the race of the doctor who cared for the newborn affected the likelihood of newborn death.
Currently, Black American newborns have three times the death rate of white newborns. But did the race of the doctor predict that?
When the researchers organized the doctors by race, they learned that Black newborns who had a white pediatrician also had three-fold higher death rate, while Black newborns with a Black pediatrician had just a two-fold higher death rate.
"Racial concordance cut the racial difference in newborn mortality by a third," said Sojourner, who found that this higher rate of Black infant mortality at the hands of white doctors came out to an additional 1,400 deaths annually.
The researchers discovered no mortality penalty for white babies born to Black doctors, moreover, meaning the racism only went in one direction, white against Black. Board Certification in pediatrics diminished but did not erase the effect.
The researchers controlled for a host of confounding variables, including the type of hospital and underlying conditions of the child. The effect was most pronounced with complex deliveries, and in hospitals with higher rates of Black newborns. The study found that maternal mortality was not affected by the race of the doctor.
The study did not address how specifically Black newborns die more often in the hands of white doctors. Sojourner believes it is an area for future research.
"We've known for a long time that there are big racial disparities in newborn mortality," Sojourner said. "I think it's hopeful to have found something associated with large reductions in that penalty... It does suggest that Black doctors are doing a better job on average in caring for Black newborns, and that we should learn from them."
It can't be a simple matter of hiring more Black doctors, he said, however, despite the fact that Blacks make up less than 5% of physicians and over 13% of the population.
"I think it certainly is important evidence of the need to figure out what's going wrong for so many families," Sojourner said. "What are Black doctors doing better than white doctors? What are hospitals doing differently?
"It could be implicit bias, it could be better communication, better trust of information that's coming from the families, or something about how the patients and doctors are matched together, that's not necessarily a difference in the room."
Correction: This story has been corrected to reflect that the study examined care of newborns by pediatricians, not obstetricians.