Investigation of Factors Contributing to Racial Differences in Sport-Related Concussion Outcomes

OBJECTIVE: Following sport-related concussion (SRC), early studies have demonstrated racial differences in time to clinical recovery; however, these differences have not been fully explained. We sought to further explore these associations by considering possible mediating/moder-ating factors.METHODS: Data from patients aged 12-18 years diag-nosed with SRC from November 2017 to October 2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded. The exposure of interest was race, dichotomized as Black/White. The primary outcome was time to clinical recovery (days from injury until the patient was either deemed recovered by an SRC provider or symptom score returned to baseline or zero.)RESULTS: A total of 389 (82%) White and 87 (18%) Black athletes with SRC were included. Black athletes more frequently reported no SRC history (83% vs. 67%, P = 0.006) and lower symptom burden at presentation (median total Post-Concussion Symptom Scale 11 vs. 23, P < 0.001) than White athletes. Black athletes achieved earlier clinical recovery (hazard ratio [HR] = 1.35, 95% CI 1.03-1.77, P = 0.030), which remained significant (HR = 1.32, 95% CI 1.002-1.73, P = 0.048) after adjusting for confounders associated with recovery but not race. A third model adding the initial Post-Concussion Symptom Scale score n ullified the association between race/recovery (HR = 1.12, 95% CI 0.85-1.48, P = 0.410). Adding prior concussion his-tory further reduced the association between race/recovery (HR = 1.01, 95% CI 0.77-1.34, P = 0.925).CONCLUSIONS: Overall, Black athletes initially pre-sented with fewer concussion symptoms than White ath-letes, despite no difference in time to clinic. Black athletes achieved earlier clinical recovery following SRC, a differ-ence explained by differences in initial symptom burden and self-reported concussion history. These crucial differ-ences may stem from cultural/psychologic/organic factors.