PM1080: Potential Disparities in Concussion Injury and Management Among Varying Populations of Young Athletes

Background: Limited current literature has suggested differences among various patient populations in receiving concussion-related care. Minority groups are less likely to present for concussion diagnosis and less likely to be diagnosed with a concussion1,2. Prior studies have shown patients belonging to minority ethnicities and those with non-private insurance tend to utilize sub-specialty concussion care less than other patients3. The purpose of this study was to further examine different patient populations and demographics for potential disparities in concussion presentation, diagnoses and injury patterns.

Methods: Data were prospectively collected from participants aged 7-18 diagnosed with a sport-related concussion and enrolled in the North Texas Concussion Registry (ConTex) between December 2015-February 2022. Demographics and clinical measures from presentation and 3-months post-enrollment were reviewed, including symptom severity scores, Generalized Anxiety Disorder (GAD-7) scale, Patient Health Questionnaire (PHQ-8), Brief Resilience Scale (BRS), return-to-play (RTP), and insurance status.

Results: 853 patients (13.97±2.17 years) were included. Among differing ethnicities, significantly more Hispanic or Latino patients had state insurance compared to Non-Hispanic or Latino patients, who were more likely to have commercial insurance (p < 0.0001) (Table 1). Non-Hispanic patients had more visits in clinic on average than Hispanic patients (2.12±0.90 vs 1.93±0.93, p=0.01). Hispanic patients took longer to present to clinic after sustaining a concussion (11.09±11.47 vs 9.16±12.50 days, p< 0.0001) and had lower baseline symptom severity scores (20.43±23.46 vs 26.88±23.38, p=0.0001). Examining insurance types among races, Black or African American patients and those identifying as more than one race were more likely to have state insurance than white and Asian patients who were more likely to have commercial (p < 0.0001).
Patients with state insurance were more likely to be injured during school sports than club or recreational, while those with commercial insurance or no insurance/self-pay had more injuries during club play (p=0.0053). State insurance patients had significantly lower symptom severity scores at presentation compared to commercial or no insurance (19.15±23.17 vs. 26.84±10.69 vs. 21.48±9.39, p=0.0002), and took longest to present (12.04±14.34 days, p=0.0013).

Conclusion: Certain sub-populations of young athletes are more likely to have worse symptom scores, take longer to present and RTP, and may not be seen as often by a treating provider as their peers after sustaining a concussion. It is important for providers to remain cognizant of different patient populations, the circumstances surrounding their financial situation, and potential barriers they may face in receiving prompt care, and to consider ways to mitigate disparities in treatment and outcomes.