Health Care Navigation of Black and White Adolescents After Sport-Related Concussion: A Path Toward Health Equity

Abstract

Context: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. Objective: To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. Design: Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. Main Outcome Measures: Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. Results: Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). Conclusions: This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population

“…Our study provides broader data assessing adherence among pediatric patients presenting to their PC provider for any injury mechanism and identifying sociodemographic and socioeconomic differences in completion of care. A study by Wallace et al39 assessed patterns of healthcare navigation among Black and White adolescents following a sports-related concussion. Contrary to our study, they found few differences between Black and White athletes in initial contact and presentation to healthcare, referral patterns, and follow-up rates within a concussion clinic, despite fewer Black athletes having private insurance than White athletes 39.…”

“…A study by Wallace et al39 assessed patterns of healthcare navigation among Black and White adolescents following a sports-related concussion. Contrary to our study, they found few differences between Black and White athletes in initial contact and presentation to healthcare, referral patterns, and follow-up rates within a concussion clinic, despite fewer Black athletes having private insurance than White athletes 39. Wallace et al39 suggest one potential reason for this outcome could be that participating in school sports may facilitate better access to healthcare.…”

Uses of Health Care System Medical Care Services by Athletes After Injury at the High School Level

“…Emergency department utilization in youth and adolescents is multi‐factorial and often include access to physician care, insurance status, transportation difficulties, and cultural and language barriers 35 . Other potential influences include injury reporting, 36 athlete and caregiver literacy, 37,38 and health care navigation 39 . These dynamics seem to increase the emergency department use for both initial and follow up care and often create a delay in receiving care 35 .…”

“… 35 Other potential influences include injury reporting, 36 athlete and caregiver literacy, 37 , 38 and health care navigation. 39 These dynamics seem to increase the emergency department use for both initial and follow up care and often create a delay in receiving care. 35 Using emergency care services for an initial diagnosis has the potential to delay access to a provider who can offer specialty treatment for the athlete's condition and may influence the timeline for recovery from injury.…”

Intersection of Race and Socioeconomic Status on Concussion Recovery among NCAA Student-Athletes: A CARE Consortium Study

“…Median household incomes follow a similar trend, with the highest median incomes reported by Asian households, followed by White and Black (11). Beyond educational attainment and financial security, race and SES often carry unique perspectives and life experiences, including racial discrimination, marginalization, and microaggressions, which may influence SRC knowledge (13), reporting (13), access to healthcare (14), and injury outcomes (15). Indeed, contemporary literature appraising the relationship between race and SRC recovery has resulted in heterogeneous findings across the intersections of age, sex, and sport contact level(s) (15)(16)(17)(18)(19)(20).…”