Sport-related Concussion Characteristics By Race, Ethnicity, And Socioeconomic Status: A Care Consortium Investigation

Social constructs, such as race, ethnicity, and socioeconomic status (SES), are of emerging interest following sport-related concussion (SRC) due to their associations with injury characteristics and clinical management. PURPOSE: To describe initial SRC presentation by race, ethnicity, and SES among a cohort of collegiate student-athletes (SAs). METHODS: The Concussion Assessment, Research, and Education (CARE) Consortium recruited SAs across 30 institutions from 2014-2022. Race and ethnicity were reported using the U.S. census categories, with racial categories binned as Black, White, and Other SAs of Color. SES was estimated via the Hollingshead 4-factor Index, which assigns values for parent/guardian education and occupation. We used a modified approach to create a continuous SES variable, with scores binned as low (3-29), middle (30-39), and high (40-66). Multivariable negative binomial regression modeling using effect estimates (ratios with 95% confidence intervals [95% CI]) were employed to evaluate predictors of time until removal from play, delayed symptom onset, and symptom severity (<48 hours) by race, ethnicity and SES after adjusting for sex, sport contact-level, and SRC history. RESULTS: Our analysis included 1,795 concussed SAs (17.9% Black; 6.1% Hispanic/Latinx; 70.0% high SES). Among SAs not immediately removed from play, Black SAs were removed sooner (Ratio 2.07 [1.44, 3.04]), whereas Other SAs of Color were removed later (Ratio 0.69, 95% CI [0.49, 0.98]), relative to White SAs. Further, Hispanic/Latinx SAs were removed later (Ratio 0.50, 95% CI [0.34, 0.78]) than non-Hispanic/Latinx SAs. Among SAs with delayed symptom onset, symptoms took longer (Ratio 0.16, 95% CI [0.09, 0.33]) to present in Hispanic/Latinx SAs compared to non-Hispanic/Latinx SAs. Lastly, high SES SAs reported lower (Ratio 0.88, 95% CI [0.79, 0.97]) initial symptom severity scores than middle SES SAs. CONCLUSION: Race and ethnicity were associated with time before removal from play, whereas ethnicity and SES were associated with delayed symptom onset and symptom severity, respectively. Further research is crucial to understand why differences across social constructs emerged, as well as develop strategies to support equitable post-SRC management. FUNDING: Supported by the NCAA-DoD (W81XWH-14-2-0151). Supported by: NCAA-DoD (W81XWH-14-2-0151)