Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion
Background: While healthcare and health outcome disparities have been studied across a variety of different injuries, their relation to concussion incidence and management are relatively understudied.
Aim: To evaluate the association between history of concussion or musculoskeletal injury, and family affluence and/or school-level measures of socioeconomic status
Methods: We conducted a cross-sectional study of adolescent athletes in a local school district. Adolescent athletes (N=192; mean age=15.3, SD=1.6 years; 49% female), who presented for a pre-participation physical evaluation reported concussion and injury history, and family affluence scale (FAS) scores. We also examined the percent of students on free/reduced lunch at each school compared to state averages. Independent variables, individual FAS score and school-based marker of socioeconomic status, were compared between those with and without a history of concussion and time-loss musculoskeletal injury.
Results: Of the participants, n=40 (21%) reported a history of concussion. Athletes with a concussion history had significantly lower FAS scores than athletes without a history of concussion (mean difference = 0.7, 95%CI= 0.1, 1.4; p=0.027). There was no significant difference in FAS scores between those with and without a history of time-loss musculoskeletal injury (mean difference=0.0, 95% CI=-0.5, 0.5; p= 0.97). Athletes with a history of concussion had a higher proportion of a prior time-loss musculoskeletal injury (68% vs. 32%; p<0.001). After adjusting for age, school free-reduced lunch rate, and history of musculoskeletal injury, a lower FAS score was associated with concussion history (adjusted odds ratio=0.79; 95% CI=0.64, 0.96; p=0.019). Concussion and musculoskeletal injury were not associated with school-level markers of socioeconomic status.
Conclusion: Lower individual, but not school-level measures of socioeconomic status were associated with a history of concussion in our sample of adolescent athletes.
Relevance for Patients: Enhance providers’ understanding of how socioeconomic factors may impact concussion history and empower providers to adequately screen for and provide concussion education to mitigate disparities.
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