Examining The Impact Of Patient-Provider Sex Concordance On Concussion Outcomes

Sex-related disparities in incidence rates, symptom manifestation, and post-injury recovery timelines have been reported among athletes with concussion. Recent evidence suggests that patients may be more comfortable disclosing medical symptoms to practitioners with similar identities to their own (e.g., sex). However, patient-provider sex concordance (i.e., matching sex identities) has yet to be examined in relation to concussion recovery timelines. PURPOSE: To investigate the association of athlete-athletic trainer (AT) sex concordance with days to symptom resolution (SR) and return-to-sport (RTS) after concussion. METHODS: A retrospective chart review was performed for concussion cases (N=1044; Female: n=456 [44%]; Male: n=588 [56%]) at 11 NCAA institutions (DI: n=8, DII: n=2, DIII: n=3) that occurred between July 2015 through February 2020. The biological sex of injured athletes and the treating AT were self-reported and extracted from preparticipation documents and injury notes. To examine the association of sex concordance with days to SR and RTS, we fit separate negative binomial regression models with incidence risk ratios (IRR) and 95% confidence intervals (95% CI) for each outcome. All models were unadjusted, as there were no significant covariates (e.g., demographic and prior medical history) following a priori evaluation. RESULTS: Most concussion cases represented sex-concordant athlete-AT pairs (n=777, 77%). There were no statistically significant differences by sex concordance on time from injury to SR (Med=7, IQR=4,13; IRR=1.10, 95% CI=0.93, 1.30) or RTS (Med=12, IQR=8,20; IRR=1.13, 95% CI=0.90, 1.42). CONCLUSION: The alignment of sex identities between athletes and ATs was not associated with post-concussion recovery trajectories for athletes in this study. This suggests that collegiate athletes may be willing to seek care for their concussion from an AT regardless of the AT’s sex. Inversely, ATs may provide equitable concussion care regardless of, or potentially with regard for, an athlete’s biological sex. Our findings may underscore the role ATs have in providing personalized and inclusive approaches to concussion care for collegiate athletes.