Socioeconomic Status And Concussion Recovery In Young Athletes

Most high school athletes improve symptomatically after concussion in approximately 2 weeks; however some adolescents experience prolonged recovery. Socioeconomic status (SES) may be a potential risk factor for prolonged concussion recovery and return to play (RTP) time, but the existing literature is limited and has yielded mixed results. PURPOSE: To determine the relationship between SES and concussion recovery in young athletes METHODS: High school and middle school athletes who sustained a diagnosed concussion while competing in sports or positions at high risk for concussion (football, soccer, hockey, wrestling, lacrosse, and pitchers/catchers in baseball/softball) from 2020 - 2023 in Southeast Minnesota were included in this retrospective study. Data obtained for each concussion include date of injury and date of clearance to begin a RTP protocol. A validated measure of SES, HOUSES (HOUsing-based index of SES), was used to determine each athletes’ SES by pairing home addresses to publicly available property data. SES was divided into 4 quartiles determined for the region (Q1 = lowest SES quartile, Q4 = highest SES quartile). A negative-bimodal regression model was used to analyze the relationship between SES and RTP time with HOUSES quartile as the independent variable. RESULTS: A total of 132 athletes (mean age 15.9 ± 1.5 years, 75% male, 81.8% white) were included in the analysis. 14 (10.6%) athletes were in Q1, 28 (21.2%) were in Q2, 31 (23.5%) were in Q3, and 59 (44.7%) were in Q4. Median RTP time was 16 days in Q1, 12 days in Q2, 13 days in Q3, and 11 days in Q4. SES and RTP time were negatively associated, with a 20% reduction in RTP time for each increase in HOUSES quartile (95% confidence interval: 10-28%, p < 0.001). CONCLUSION: RTP time after concussion may be related to SES in young athletes, with higher SES associated with shorter RTP timelines. These differences may be explained by variations in health care access and pre-existing conditions (e.g. mood and learning disorders) between athletes of different SES. Mayo Foundation for Medical Education & Research and NIH R21 AG065639