Evidence of systemic racism when delivering babies

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SuperMatt

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They found a tantalizing statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half.
"Strikingly, these effects appear to manifest more strongly in more complicated cases," the researchers wrote, "and when hospitals deliver more Black newborns." They found no similar relationship between White doctors and White births. Nor did they find a difference in maternal death rates when the doctor's race was the same as the patient's.
 
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thekev

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The study examines births in Florida from 1992 to 2015. They also mention this in their abstract.

We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

I would probably want to know their covariates here. Florida is a single state, with several impoverished Black populations. Part of that poverty is almost certainly attributable to racism, but I'm wondering if it's a more direct factor. It could impact pre-natal care and the quality of surrounding hospitals and clinics.

I quoted the section from the abstract, because I wanted to mention that it matters what you examine.
 

P_X

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Overall, there are some issues with the paper, but very interesting. I had to read 70% of the article to be able to interpret the tables, which are just the results of step-wise binary regression modeling. My grievance is that it's written by public health/business researchers, not physicians. This takes absolutely nothing away from the research, but physicians write in a much more TL;DR way. Overall, my main comment as a limitation is that they don't eliminate the resident physician effect...pediatrics is different, but where I trained the residents did 95% of hands-on patient care and had a huge impact on decision making.

Overall, I'd say this is interesting, provocative, and neither the authors, nor can I explain the findings without jumping into conclusions. However, this is the kind of study they can build an entire career on, so we'll learn a lot more about this in the future.


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SuperMatt

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Overall, there are some issues with the paper, but very interesting. I had to read 70% of the article to be able to interpret the tables, which are just the results of step-wise binary regression modeling. My grievance is that it's written by public health/business researchers, not physicians. This takes absolutely nothing away from the research, but physicians write in a much more TL;DR way. Overall, my main comment as a limitation is that they don't eliminate the resident physician effect...pediatrics is different, but where I trained the residents did 95% of hands-on patient care and had a huge impact on decision making.

Overall, I'd say this is interesting, provocative, and neither the authors, nor can I explain the findings without jumping into conclusions. However, this is the kind of study they can build an entire career on, so we'll learn a lot more about this in the future.


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I truly appreciate your expert perspective on studies like this. It brings a lot to this forum. Thank you!
 

P_X

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I truly appreciate your expert perspective on studies like this. It brings a lot to this forum. Thank you!
Thank you for sharing this. One thing that is hard to swallow, is superficially rapport shouldn't play a role with neonates. The authors adjusted the model for so many things (comorbidity, insurance status, hospital effect). They didn't (couldn't) directly adjust for household income, but some of these are captured in insurance status, and the black concordance effect persisted. I suspect it still improves with higher earning black families, but again, that's a future study. (These data are captured on a very large scale, so I'd expect a follow up on it using other databases).

One thing that I don't think databases like this capture is longer term outcomes and the physician perception of those and the effect of that on short-term decision-making.

One of the toughest things in US healthcare is to explain futile care to African-American families. In general they trust me more because I'm black too, but they don't trust the system. And why would they. Just because our standards are higher today and I think we do go the extra mile to try to do an even job across the board, it historically hadn't been the case.
 
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