Black Newborn Mortality is Not About Race

In August 2020, a leading scientific journal published an article with a curious and revolutionary finding.

The study “suggest[s] that when black newborns are cared for by black physicians, the mortality penalty they suffer, as compared with White infants, is halved.”

A very dramatic and consequential finding indeed.

Especially, as the authors explain, “black newborns die at three times the rate of White newborns” in America.

This analysis examined births in Florida hospitals from 1992 to 2015, finding white babies had a mortality rate of 0.3% regardless of the race of the attending physician. However, black babies had a rate of 0.9% if cared for by White physicians. But that percentage dropped dramatically to 0.4% if cared for by black physicians.

This was indeed very good news.

But it raises immediate questions. Do black physicians provide better quality care than white physicians? Are they able to treat babies who share their skin color more effectively?

This is a reasonable assumption from the data. Do babies just seem to respond better to physicians who share their own skin color? Of course, babies would need to be aware of their race at birth for this to be a factor.

Regardless, it is a very interesting and potentially consequential finding for baby health, medical ethics and management, racial politics and our nation’s debate on affirmative action.

In fact, Supreme Court Justice Ketanji Brown Jackson cited this research in her dissent in Students for Fair Admissions v. Harvard, a ground-breaking 2023 affirmative action decision. But Justice Jackson made a dramatic mistake in how she interpreted the study’s findings, as explained by The Wall Street Journal.

However, new research, published in the same journal where the original 2020 study appeared, brings significant clarity to this finding.

These new scholars explain, “The estimated racial concordance effect is substantially weakened, and often becomes statistically insignificant, after controlling for the impact of very low birth weights on mortality [emphasis added].” Specifically, they clarify,

It turns out that a disproportionately large number of black newborns with very low birth weights are attended by white physicians. We show that once we control for the impact of very low birth weights on mortality, the estimate of the racial concordance effect is substantially weakened and becomes statistically insignificant in models that account for other factors that determine newborn mortality.

In a less technical explanation of their findings published over at the Institute for Family Studies, these authors inform us,

[ENTER TEXT HERE]

In our data, about 10% of white babies have black doctors regardless of their weight. By contrast, the share of black babies with black doctors varies substantially by weight. More than 20% percent of black newborns with healthy weights have black doctors, whether owing to patient choice, matching by hospital staff, or other factors. But for black babies with the lowest birth weights, this share falls to the roughly 10% seen among white babies. 

Here is the clarifying data point: “As a result, only 1.4% of black babies attended by black doctors have very low birth weights, but 3.4% of black babies attended by white doctors have this serious health condition.”

In other words, what appeared to be a substantial racial issue actually just turned out to be about the original scholars failing to measure for a very vital confounding data point.

These scholars interpret what this means by implication: “Because very low birth weights are a strong predictor of mortality, and because black newborns with this condition disproportionately see white doctors, white doctor/black patient combinations will appear particularly lethal unless one accounts for the condition directly.”

In other words, what appeared to be a substantial racial issue actually just turned out to be about the original scholars failing to measure for a very vital confounding data point.

The authors of this second study make a very important follow-up point about how we know what we know and how science should work.

There are important lessons for science here. Everyday consumers of scientific findings should maintain a healthy skepticism, because seemingly minor tweaks to statistical models often substantially change results. And just as important, scientists can improve the process by being open to challenge.

When good scholars are honest about their work, open to scientific rigor, good things can happen. “We were able to replicate the original study because the authors provided us the necessary information, answered our questions, and gave helpful feedback on the original draft of our paper.”

This is how scientific investigation and reporting should work. It helps us understand how to truly ensure scholars are making correct conclusions. When this happens, policy makers and medical professionals can make the best decisions for our children’s care and well-being.

Image from Shutterstock

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