All ETDs from UAB

Advisory Committee Chair

Elizabeth Baker

Advisory Committee Members

Verna M Keith

Namasivayam Ambalavanan

Document Type

Thesis

Date of Award

2023

Abstract

“Wimpy White Boy Syndrome” (WWBS) is a social phenomenon and belief that exists in the neonatal intensive care unit (NICU), where white boys fare the worst and Black girls fare the best. However, this belief is based on little to no empirical evidence and contradicts the majority of the research that documents Black Americans tend to have worse health outcomes than white Americans. Utilizing electronic medical record data from a Southern, regional, and level IV neonatal intensive care unit, this research project explored racial differences in length of hospital stay, mortality, and resource allocation among low and very low birthweight infants. Using Cox Proportional Hazard Modeling, I find that Black babies have a lower hazard of discharge to home (HR: 0.842; p<0.001) and have a slightly higher hazard of mortality (HR:1.561; p=0.061) compared to white babies. However, once differences in health are accounted for by controlling for gestational age, respiratory distress, sepsis, and maternal health conditions, Black babies are no longer less likely to discharge (HR: 1.064; p=0.132). Additionally, I found that racial differences in time until discharge vary by gender, such that racial differences were more pronounced for boys (HR: 1.155; p<0.05 for Black babies and HR: 1.246; p<0.01 for other babies). Lastly, I found similar racial differences regarding hospital charges. Black babies have higher hospital charges but controlling for health accounts for these differences. If the concept of “Wimpy White Boy Syndrome” is grounded in racial differences in health, I would find that white male babies would be less likely to be discharged to home compared to other racial groups and this potential difference should be accounted for by health. However, this research finds that it is only after accounting for health that Black male babies are more likely to be discharged to home compared to white male babies. This finding is discussed in light of the concept of self-fulfilling prophecy, where the providers take actions because of their beliefs about wimpy white boys leading them to be less likely to be discharged, and then the results of those actions confirm their beliefs (Merton 1948).

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