Examining Concussion Nondisclosure in Collegiate Athletes Using a Health Disparities Framework and Consideration of Social Determinants of Health

Wallace, Jessica; Beidler, Erica; Register-Mihalik, Johna K.; Hibbler, Tamaria; Bretzin, Abigail C.; DeMedal, Spencer; Kerr, Zachary Y.

doi:10.4085/1062-6050-0054.21

Cited by 16 publications

(3 citation statements)

References 35 publications

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“…The included research articles were classified into five mutually exclusive primary focus areas during the data extraction phase: (1) access to and participation in sports , (2) access to SEM care , (3) health-related outcomes in SEM , (4) study methodology and (5) provider representation in SEM (table 1, online supplemental table S4). Most included studies were related to access to and participation in sports (n=45, 44%),17–61 followed by access to SEM care (n=28, 27%),62–89 health-related outcomes in SEM (n=24, 23%),90–113 provider representation in SEM (n=5, 5%)114–118 and methodology (n=1, 1%) 119…”

Section: Resultsmentioning

confidence: 99%

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

Kliethermes,

Asif,

Blauwet

et al. 2024

Br J Sports Med

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ObjectiveHealth disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base.DesignScoping review.Data sourcesSystematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials.Eligibility criteriaFull-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included.Results103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90).ConclusionHealth disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

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Section: Resultsmentioning

confidence: 99%

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

Kliethermes,

Asif,

Blauwet

et al. 2024

Br J Sports Med

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“…Indeed, racial and SES privileges are unique constructs with intertwined effects (38). SES is a well-documented social determinant of health that influences access, care, and overall experience with the medical system before arriving at a college campus (39). Additional research is warranted at the collegiate level to understand how SA race and SES relative to their medical providers may influence their willingness/likelihood to seek care and/or the quality of care they receive.…”

Section: Discussionmentioning

confidence: 99%

Intersection of Race and Socioeconomic Status on Concussion Recovery among NCAA Student-Athletes: A CARE Consortium Study

Boltz

Memmini

Brett

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose To 1) describe collegiate student-athlete(SA) race and household income, and 2) evaluate time to normal academic performance (i.e., return to learn[RTL]), initiation of the return to play(iRTP) protocol, RTP protocol duration, and time to unrestricted RTP(URTP) after sustaining sport-related concussion(SRC). Methods Data were collected between 2014-2020 by the Concussion Assessment, Research, and Education (CARE) Consortium. Baseline data were used to characterize participant demographics(N = 22,819) and post-SRC outcomes(n = 5485 SRCs) in time to RTL(n = 1724) and RTP outcomes(n = 2646) by race. Descriptive statistics and non-parametric tests examined differences across race by demographic and injury characteristics. Kaplan-Meier curves estimated median days to RTL, iRTP protocol, RTP protocol completion, and URTP by race and covariate measures. Multivariable Cox-Proportional Hazards regression assessed the effect of race on risk of RTL and RTP recovery timepoints. Results SAs largely identified as White(75%) followed by Black(14%), Multi-Racial(7%), and Asian(3%). More than half(53%) of all SAs reported a household income of >$120,000, while 41% of Black SAs reported a household income <$60,000. Race was not associated with relative risk of RTL or iRTP, but was associated RTP protocol completion, and URTP. Non-Black/Non-White SAs were 17% less likely(HRAdj = 0.83; 95% CI = 0.71, 0.97) to complete the RTP protocol, and Black SAs 17% more likely (HRAdj = 1.17; 95% CI = 1.05, 1.31) to reach the URTP timepoint compared to White SAs. Conclusions The present findings suggest collegiate SAs enrolled in the CARE Consortium are primarily White, and come from household incomes well above the U.S. median. Race was not associated with RTL or iRTP, but was associated with RTP protocol duration and total time to URTP. Clinicians should be conscientious of how their implicit or preconceived biases may influence SRC management among NCAA student-athletes.

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“…Fourth, and related to clinical outcomes, we must strive for inclusion of social determinants of health in study designs, particularly in accounting for concussion history. Recent research has revealed that although approximately equivalent percentages of White and Black athletes reported a history of concussion nondisclosure, reasons for nondisclosure differed by race [ 51 ]. Moreover, social determinants warrant consideration in the assessment of clinical outcomes following concussion, because factors such as health insurance (public vs. private), commonly cited as a proxy for socioeconomic status, have been associated with time to return to school [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome Following Concussion Among College Athletes with a History of Prior Concussion: A Systematic Review

et al. 2022

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Background There is long-standing interest in, and concern about, whether collegiate athletes with a history of concussion will experience worse clinical outcomes, or prolonged recovery, should they sustain a subsequent concussion. Objectives This systematic review examined the association between prior concussion history and clinical outcomes following a subsequent sport-related concussion among college-age student athletes. Study Design Systematic review. Methods We screened 5,118 abstracts and 619 full-text articles that were appraised to determine whether they met inclusion criteria. We utilized a likelihood heuristic to assess the probability of observing a specific number of statistically significant and nonsignificant studies reporting an association between concussion history and clinical outcomes. We conducted a narrative synthesis of the study findings. Results Sixteen studies met the inclusion criteria. Thirteen studies reported the number of participants with a history of prior concussions (≥ 1), which totaled 1690 of 4573 total participants (on average 37.0% of study participants; median = 46.0%, range 5.6–63.8%). On the Newcastle–Ottawa Quality Assessment Scale, the risk of bias ratings ranged from 3 to 9 (mean = 5.4, SD = 1.4). Across all studies, 43.8% (k = 7/16) reported at least one statistically significant result among primary analyses showing an association between concussion history and worse clinical outcome. A minority of studies reporting on symptom duration (4/13, 30.8%) and time to return to play (2/7, 28.6%) found an association between concussion history and worse outcome. Studies included in the review reported limited information pertaining to the characteristics of prior concussions, such as presence or duration of loss of consciousness or posttraumatic amnesia, age at first lifetime concussion, time since most recent past concussion, or length of recovery from prior concussions. Conclusion The question of whether college athletes with a prior history of concussion have worse clinical outcome from their next sport-related concussion remains unresolved. The published results are mixed and in aggregate show modest evidence for an association. Many studies have small samples, and only three studies were designed specifically to address this research question. Important outcomes, such as time to return to academics, have not been adequately studied. Larger hypothesis-driven studies considering the number of prior concussions (e.g., 3 or more) are needed. Trial registration: PROSPERO CRD42016041479, CRD42019128300.

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Examining Concussion Nondisclosure in Collegiate Athletes Using a Health Disparities Framework and Consideration of Social Determinants of Health

Cited by 16 publications

References 35 publications

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

Intersection of Race and Socioeconomic Status on Concussion Recovery among NCAA Student-Athletes: A CARE Consortium Study

Clinical Outcome Following Concussion Among College Athletes with a History of Prior Concussion: A Systematic Review

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