Poverty, lack of access to health care and resources, and biological predispositions have previously been used to explain why Black people die and experience complications post-surgery at higher rates. 

But according to new research published Monday in the journal Pediatrics — which, for the first time, included data among healthy and generally low-risk children across racial groups — even healthy Black children are more likely to suffer complications and die than white children post-surgery.

The researchers concluded that other factors are leading to racial disparities — and this new information may guide future studies in identifying them.

"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," Olubukola Nafiu, pediatric anesthesiologist and lead author of the study, said in a press release.  

Researchers studied 172,549 children under the age of 17 included in the National Surgical Quality Improvement Program-Pediatric database from 2012 to 2017. The database collected the outcomes of children undergoing surgical procedures at different medical sites in the US.

Children included in the database ranged from healthy to having a mild disease, such as a seizure disorder. More children were mildly sick than healthy and had similarly low rates of different disorders and diseases before surgery regardless of race.

While the database showed post-surgery death, complications, and adverse effects were low overall, Black children were 3.5 times more likely to die within 30 days after undergoing surgery and had an 18% greater chance of developing complications than white children. 

The higher death rates might be explained by Black children experiencing more seriously harmful events after the surgery, the study said.

Black children also had a 7% higher probability of developing serious adverse effects that required blood transfusions and sepsis. What’s more, Black children were at higher risk for undergoing surgeries and intubations for a second time that weren't originally planned.

The study did not conclude if children experienced complications or died as a result of where they received treatment, as the database omitted hospital names. It was also unclear if lack of diversity or implicit bias affected children’s outcomes, according to CNN. 

However, communication between physician and patient, and bias among health care providers, has been shown to impact how patients recover after surgery, the study said.

“This study boasts a number of strengths, the main one being that it utilizes a large national sample, which gives us an idea of population-level trends,” said Dr. Nia Heard-Garris, pediatrician-researcher at the Ann & Robert H. Lurie Children’s Hospital of Chicago and chair of the Section on Minority Health, Equity, and Inclusion at the American Academy of Pediatrics, who is not affiliated with the study.

But Heard-Garris wants to shift the conversation around Black children's health toward focusing on addressing inequities that put them at a disadvantage.

“This messaging that something is inherently wrong with African American children, perhaps not captured in the study, is problematic,” Heard-Garris told Global Citizen. “Though race is a social construct, skin color — often a proxy for race — is immutable and, therefore, should not be the focus of our attention. Our intense focus should be on the drivers of these disparities and working tirelessly to correct them.”

Nafiu stressed that race is not the cause of these outcomes, but that it is definitely linked to them. Now, he and his team are tasked with coming up with a solution.

"Our next job is to look at what postoperative complications are driving the observed morbidity and mortality pattern in order to identify modifiable outcomes," Nafiu said.

Update, July 21, 10:47 a.m. ET: This story has been updated to add comments from Dr. Nia Heard-Garris.

Update, July 23, 4:43 p.m. ET: This story has been updated to clarify the significance of the new research in contrast to previous studies.