When Black people go to the hospital, they are often confronted with far more challenges than white people due to structural racism. That sometimes means that the outcomes for healthy individuals have very different results. It's been well-documented in the past that Black people have higher rates of poor outcomes after surgery than white people. But now we're learning that the same is true for Black children, who are lower-risk patients.
A new study published in the journal Pediatrics shows that Black kids are nearly 3.5 times more likely to die within 30 days of surgery than white children. The new research is pretty jarring. While in older individuals a case could be made for higher rates of chronic diseases in Black people, that is less convincing when it comes to children who have fewer risk factors all around. Racial bias definitely seems to be at play.
Surgery results in healthy children of different races hadn't been studied until now. So these new results are pretty groundbreaking.
These findings are incredibly important. "Healthy kids have low complication rates," said Dr. Olubukola Nafiu, lead author of the study and pediatric anesthesiologist and vice chair for academic affairs and research at Nationwide Children's Hospital, in a press release. "The expectation should be that complication rates and/or mortality among healthy children won't vary based on racial category — what we found is that they do," Dr. Nafiu said.
It's startling, and yet it shouldn't be all that surprising. Racial bias exists just about everywhere, and it certainly exists in hospitals. Black women die in childbirth at far higher rates than white women. And it's been well-documented that the same surgeries have far different results for Black people than white people.
Still, it's incredibly upsetting to realize that children could be treated so differently when getting medical care. But the results are hard to avoid and certainly point to racial bias. Researchers looked at data from 173,000 operations from 2012 through 2017. Those cases involved children younger than 17 who were considered healthy prior to surgery.
The results are stunning. Researchers found that 23 Black children died within 30 days of surgery compared with just 13 white children. That is no small number when it comes to children who do not have the same risk factors as adults and were considered "healthy."
"Although these findings are unsurprising, they are still nonetheless terrifying and unacceptable," said Chicago pediatrician Dr. Nia Heard-Garris, who chairs the Minority Health, Equity and Inclusion Committee of the American Academy of Pediatrics. "To think of any children dying after surgery is distressing; however, children who have no or mild illness prior to surgery and to go on to experience complications, adverse events, or even death requires immediate attention and action," she said. She also called the deaths "inexcusable." That's because it seems clear many of those deaths are the result of a lower standard of care.
Black children were also at higher risk for developing complications by about 18%, the study showed. They had a 7% higher chance of serious adverse effects. They were also at a greater risk for needing second surgeries that weren't part of the initial plan.
Overall, the new statistics are frightening. As if the parents of Black children didn't have enough to worry about in today's culture, where the impacts of structural racism are really being exposed in a new way, this new study sheds light on another deeply disturbing and unavoidable issue. The fact that it's being exposed, however, is certainly a good thing.
Of course, there are plenty of factors that need to be examined, as with any new research. Aside from pre-surgery disease or other potential risk factors, other factors such as poverty and less access to health care should all be examined. But another big factor could be communication between doctors and patients, researchers say.
California pediatrician Dr. Rhea Boyd says the findings are disturbing. They "further illustrate the ways racism shapes health outcomes in this country," she says.
While there is always more research to be done, and looking at how to fix the problem will be the next step, it's hard to avoid how shockingly different the results of surgery between Black children and white children are. Most experts seem to agree that racism is the biggest component of those results.
"Racism, not race, is a critical determinant of health," Dr. Boyd says. "Racism makes people sick and contributes to premature death, even for our kids."
While we've long known that racism exists in health care, maybe these new results looking at the impacts on kids will finally help to create real change, because all kids deserve quality treatment. This new research should be a huge wake-up call to providers everywhere.
