Disparities on Baseline Performance Using Neurocognitive and Oculomotor Clinical Measures of Concussion

Abstract

Background: Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion. Purpose: To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual’s participating high school was a Title I or non–Title I school. A series of multivariable linear regression analyses were conducted to evaluate the association of computerized neurocognitive test scores (verbal memory, visual memory, motor processing speed, and reaction time), symptom severity scores, and KD scores by race and SES. Results: White/non-Hispanic individuals performed significantly better than Black/African American individuals on verbal memory ( P < .01), visual memory ( P < .01), visual motor processing speed ( P < .01), and reaction time ( P < .01) and had a lower symptom score ( P < .01). Regarding SES, individuals from non–Title I schools performed better on visual memory ( P = .05) and reaction time ( P = .02) than individuals from Title I schools. Examination of cumulative KD test reading time revealed that there was no association between race on baseline reading times ( P = .12). There was a significant association between cumulative reading time and SES ( P = .02). Individuals from non–Title I schools performed significantly faster than individuals from Title I schools on KD test time. Conclusion: Overall, race and SES influence neurocognitive and oculomotor concussion baseline performance in high school athletes. These findings add to the growing literature on the influence of race and SES on neurocognitive and oculomotor function baseline concussion assessments; they highlight the necessity for individualized concussion baseline measurements or race-specific normative reference values.

Optimizing Concussion Care Seeking: A Longitudinal Analysis of Recovery

“…Past research has considered these covariates to be associated with concussion care-seeking behavior and/or performance on outcomes measured in this study. 10,11,19,35,40,41 We emphasize that race and ethnicity are included in this study as proxy variables for experiences of structural racism.…”

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods

“…We emphasize that mobile EEG testing, especially when combined with community-engaged methods, provides an opportunity to improve the representation of underrepresented populations. Predominantly Black high schools, as identified in our population here, are more often Title I schools that face resource limitations, commonly lacking access to healthcare professionals ( 8 ), education about brain injuries ( 10 , 68 , 69 ) and diagnostic tools used for concussion and treatment ( 68 , 70 ). As a result of historical systemic racism, poverty disproportionately affects Black people compared to White people in the U.S. ( 71 ).…”

“…Racial and socioeconomic differences exist in concussion awareness and attitudes ( 72 ), diagnosis ( 73 ), treatment, and outcomes ( 10 , 74 ). Further, there are racial and socioeconomic disparities in performance on widely used computerized neurocognitive tests that are attributed to social determinants of health and a lack of cultural equivalence within the test ( 70 ). Systemic barriers such as the lack of concussion education and minimal-to-no access to trained health professionals within many urban and/or Title I schools puts adolescent athletes at a higher risk of having a concussion go undiagnosed and experiencing serious neurological symptoms throughout the lifespan.…”

The time is now: why we must identify and address health disparities in sport and recreation injury

“…Sport and recreational injury (SRI) epidemiology frequently examines differences by sex, yet there is limited population level literature (U.S. Department of Health Human Services 2010 ; Lyons et al 2019 ; Wallace et al 2020a ; Wallace et al 2020b ; Waterman et al 2012 ) outside of the sociology of sport (DeLuca 2013 ; Hermann and Vollmeyer 2016 ; Tate et al 2015 ; Slater and Tiggemann 2010 ; McHale et al 2005 ; Wiley et al 2000 ; Atkinson and Martin 2020 ) that demonstrates the regular inclusion of other social and structural determinants of health (SDOH), e.g. gender, disability, food insecurity, race, or ethnicity in data collection or as explanatory factors for SRI despite an emphasis on capturing and using factors such as gender by the US Department of Health and Human Services (Healthy People 2030 ; Institute of Medicine (US) Board on the Health of Select Populations n.d. ; Sex and Gender n.d. ).…”