New Issue Brief: Do Black Newborns Fare Better with Black Doctors?

Very low birth weights—not the doctor’s race—are a strong predictor of neonatal mortality

NEW YORK, NEW YORK – A 2020 study published in the Proceedings of the National Academy of Sciences (PNAS) claimed that black newborns had better survival rates when treated by black physicians. This finding, based on Florida hospital data, generated widespread media coverage and was recently cited in Justice Ketanji Brown Jackson’s dissent in Students for Fair Admissions v. Harvard. But does it hold water? Manhattan Institute fellows George Borjas and Robert VerBruggen reanalyzed the same dataset and found that racial concordance between doctor and patient is statistically insignificant when controlling for the problem of very low birth weight. Their findings, published in a recent PNAS article, are summarized in a new Manhattan Institute issue brief.

The original 2020 study claimed that black babies were less likely to die if treated by a black physician. Although the original study controlled for 65 common health conditions, Borjas and VerBruggen found it did not include a variable for whether a newborn had a very low birth weight—a key factor in neonatal mortality. In the dataset analyzed, black doctors disproportionately cared for healthier black newborns with normal birth weights, while white doctors cared for a disproportionately higher number black newborns with very low birth weights. Because very low birth weight is 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. 

Given this more complete picture, Borjas and VerBruggen conclude that the potential for improving neonatal outcomes for black infants lies more in reducing the incidence of newborns born with very low birth weights—and in improving care for those infants—than in the color of their doctors’ skin. These findings also underscore the importance of thorough data analysis and the potential for varying interpretations.  

Click here to view the full issue brief.