The coronavirus pandemic has put a spotlight on the health disparities between black and white Americans. With higher rates of hypertension, diabetes, and asthma, African Americans have been hit hard by the virus in recent months. Black patients are more likely to be uninsured than their white counterparts. The average net worth of black households is just a tenth of the average white family, further limiting this demographic’s access to care.
But a new study shows that these differences may start at birth.
Researchers recently discovered that black infants are more likely to survive when cared for by a black physician. Providers are using this information to glean new insights into the health disparities between black and white Americans.
Reducing the Infant Mortality Rate
The race of a child can have a major bearing on their chances of survival. The infant mortality rate for black infants is more than twice as high as it is for white infants. Around 10.8 black babies die per 1,000 births, compared to 4.6 fatalities per 1,000 births for white babies.
However, a new study published in the Proceedings of the National Academy of Sciences shows that the race of the attending physician can have a major effect on the health of the child.
Researchers looked at babies born in Florida from 1992 to 2015, and found that, when attended by a white physician, black newborns experienced 430 more deaths per 100,000 births than white newborns. Yet, when attended by a black physician, black newborns experienced 173 more deaths per 100,000 births than white newborns, nearly cutting the disparity in half.
This means that when a black infant is cared for by a black physician, the child’s chances of dying prematurely go down by around 50%.
Although the disparity was dramatically reduced, black babies still died at a higher rate than white babies, regardless of the race of the attending physician, which shows that other factors are at play, such as the fact that black women are less likely to have uninterrupted health insurance before, during, and after pregnancy.
When the race or gender of the patient matches that of the provider, this is what’s known as concordance. Several studies have shown that concordance can improve the rapport between doctors and patients. Individuals are also more likely to follow the doctor’s treatment recommendations and take the required medication when they are a part of the same demographic. For example, a female patient may have an easier time talking to a female primary care provider, leading to a higher comprehension of medical discussions and a better understanding of pharmaceutical information.
Going Beyond the Data
Having a physician that’s the same race as the infant may increase the child’s chances of survival, but the authors of the study are quick to point out that they do not recommend that all black babies should be cared for by black doctors, as this would create “a Jim Crow era of medicine” where black patients can only see black doctors.
Instead, the authors want providers to look at the bigger picture. For example, why does the race of the physician have such a big impact on the health of the infant?
The answer isn’t exactly clear, but the results are eye-catching, nonetheless. Some researchers believe that black mothers may feel more at ease in the delivery room when they are cared for by a black doctor. The attending physician may be more familiar with the patient’s background and more understanding of their life experiences.
Others say black Americans tend to suffer from faster rates of cellular aging, or early aging. This is what’s known as the weathering hypothesis, which suggests that continuous exposure to racism can have a physical effect on the body. All that excess stress can lead to cellular wear and tear, which can result in a range of negative health outcomes, including higher rates of infant mortality. For some black patients, seeing a black physician may reduce the effects of cellular aging.
The authors also want to make clear that they are not trying to demonize certain doctors or label providers as inherently racist.
As Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota School of Public Health in Minneapolis, says about the study, “We need to be thinking about and exploring what this means in a broader context of how we ensure equity in our society.”
This data can help us reduce health disparities among black and white Americans. Keep this information in mind as you consider what’s best for your patients.