Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion

Kartik Sidhar; Christine M Baugh; Julie C Wilson; Jack Spittler; Gregory A Walker; Aubrey M Armento; David R Howell

Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion

J Clin Transl Res. 2022 Jul 18;8(4):292-298. eCollection 2022 Aug 29.

Authors

Kartik Sidhar^{1

2}, Christine M Baugh^{3

4}, Julie C Wilson^{1

2

5}, Jack Spittler⁶, Gregory A Walker^{1

2}, Aubrey M Armento^{1

2}, David R Howell^{1

2}

Affiliations

¹ Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.
² Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
³ Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
⁶ Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

PMID: 35975186
PMCID: PMC9373721

Abstract

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: The aim of this study was 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, 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 measures, 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.

Keywords: Concussion; athlete; health disparity; mild traumatic brain injury; musculoskeletal injury.