Racial Differences Identified in Concussion Recovery in Black and White Athletes

Neurology Advisor

November 8, 2021

Black athletes reached an asymptomatic status and went back to school earlier following sport-related concussion, according to study results published in the Journal of Neurosurgery: Pediatrics.

Prior research has identified several risk factors that impact recovery following sport-related concussion, but there is a dearth of research on the association of race on sport-related concussion or its aftermath, according to the study authors. Racism and racial biases have impacted health outcomes. The objective of the study was to compare outcomes and management of sport-related concussion among Black and White athletes.

The researchers included data of 247 (211 White, 36 Black; 57.8% White males, 77.8% Black males) pediatric and collegiate student-athletes (aged 12 to 23 years) in middle Tennessee, northern Alabama, and southern Kentucky who had complete data in the Vanderbilt Sports Concussion Center outcome registry database of individuals evaluated after sport-related concussion. Patients with attention deficit hyperactivity disorder (ADHD)/learning disability (LD), depression, anxiety, or psychiatric disorder were excluded to limit confounders. The researchers interviewed patients 3 months after initial concussion or until symptoms resolved, up to 1 year after the injury, to obtain demographic, medical history, concussion-related, and insurance information.

White athletes (94%) were more likely to have private insurance and higher median income (56% ≥ 80th percentile) compared with Black athletes (67%, 41% in 0-59th median income percentile). Athletes in zip codes with higher median incomes (60th-79th percentiles compared with lowest income tier) were more likely to return earlier to school (HR 1.506 P =.041).

Symptom resolution occurred at a median 21.0 days (IQR 10.5-61.0 days) for White athletes and a median 12.3 days (IQR 6.8-28.0 days) for Black athletes (P =.026). Multivariable analysis indicated Black athletes reached asymptomatic status more quickly compared with White athletes (HR 1.497 P =.042) and male athletes reached it sooner compared with female athletes (HR 1.508 P =.004).

Returns to school tended to occur after 2 days for White athletes and after 0 days for Black athletes (P =.010). That shorter time association was held through multivariable analysis (HR 1.522 P =.040).

Compared with prior to concussion, White athletes were more likely to report decreases in sleeping (19% vs. 5.6%), doing schoolwork (57.8% vs. 41.7%), and watching television (63.5% vs. 52.8%) compared with Black athletes. In multivariable analysis, Black race was linked with lower odds of reporting activity change after concussion (OR 0.368, P =.049).

Proportionately, Black athletes (including 4 basketball, 4 football, 1 soccer) more often said they changed protective equipment (25.0% vs. 12.3%) compared with White athletes (including 2 basketball, 16 football, 6 soccer), but link between race and sport behavior change was lost after adjusting for age, sex, concussion history, and zip code median income.

Study limitations involved subjective outcome measures and the inability to generalize outside an outpatient concussion center, recall bias, lack of specificity of equipment changes, lack of time interval data between concussion and any previous concussion, and specificity of zip codes to determine median household income.

“Racial differences appear to exist in the outcomes and experience of [sport-related concussion] SRC for young athletes, as Black athletes reached [symptom resolution] SR and return to school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment,” the researchers concluded.

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