Racial and ethnic representation in concussion research: a call for methodological and analytical reform

Concussion is a critical public health issue, with approximately one in five adolescents and a substantial number of college athletes reporting a lifetime history of concussion. The impact of concussion on cognitive health may extend across the lifespan, increasing the risk of potential long-term cognitive impairments, such as dementia. Although concussion research continues to grow and incorporate athlete demographic factors, it overwhelmingly includes singular comparisons between Black or African American versus White individuals when considering race as a determinant of health. This narrow analytic lens fails to capture the increasing demographic diversity in the United States (US), where the multiracial population has risen by over 200% from 2010 to 2020, and the percentage of individuals identifying solely as White alone has declined. As a result, current research practices risk overlooking meaningful social subgroup differences that could inform equitable concussion prevention and recovery efforts. We examined how race and ethnicity are inconsistently defined and underreported in concussion research. Current practices, such as collapsing diverse social identities into “non-White” or omitting them entirely, limit clinical relevance and perpetuate structural health inequities. We advocate for more inclusive representation and methodological rigor in future studies. We propose three key actions. First, design research questions that explicitly center inclusion, moving beyond binary racial comparisons and capturing the experiences of underrepresented groups such as American Indian or Alaska Native, Asian, Hispanic or Latino, and multiracial/ethnic populations. Second, leverage robust, publicly available and nationally representative datasets, such as the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System, the Strong Heart Study, and All of Us. Third, apply rigorous analytical approaches, such as stratification, the use of interaction terms, heterogeneity tests, and/or subgroup analyses, rather than limiting analysis to adjustment for race and ethnicity as possible confounding variables in statistical models. To advance health equity in concussion research, it is essential to improve diverse demographic representation, apply rigorous analytic methods, and acknowledge the structural determinants that shape disparate outcomes. Our recommendations aim to guide researchers, funders, and policymakers toward a more inclusive and impactful research agenda.