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

Abstract

Purpose To 1) describe collegiate student-athlete(SA) race and household income, and 2) evaluate time to normal academic performance (i.e., return to learn[RTL]), initiation of the return to play(iRTP) protocol, RTP protocol duration, and time to unrestricted RTP(URTP) after sustaining sport-related concussion(SRC). Methods Data were collected between 2014-2020 by the Concussion Assessment, Research, and Education (CARE) Consortium. Baseline data were used to characterize participant demographics(N = 22,819) and post-SRC outcomes(n = 5485 SRCs) in time to RTL(n = 1724) and RTP outcomes(n = 2646) by race. Descriptive statistics and non-parametric tests examined differences across race by demographic and injury characteristics. Kaplan-Meier curves estimated median days to RTL, iRTP protocol, RTP protocol completion, and URTP by race and covariate measures. Multivariable Cox-Proportional Hazards regression assessed the effect of race on risk of RTL and RTP recovery timepoints. Results SAs largely identified as White(75%) followed by Black(14%), Multi-Racial(7%), and Asian(3%). More than half(53%) of all SAs reported a household income of >$120,000, while 41% of Black SAs reported a household income <$60,000. Race was not associated with relative risk of RTL or iRTP, but was associated RTP protocol completion, and URTP. Non-Black/Non-White SAs were 17% less likely(HRAdj = 0.83; 95% CI = 0.71, 0.97) to complete the RTP protocol, and Black SAs 17% more likely (HRAdj = 1.17; 95% CI = 1.05, 1.31) to reach the URTP timepoint compared to White SAs. Conclusions The present findings suggest collegiate SAs enrolled in the CARE Consortium are primarily White, and come from household incomes well above the U.S. median. Race was not associated with RTL or iRTP, but was associated with RTP protocol duration and total time to URTP. Clinicians should be conscientious of how their implicit or preconceived biases may influence SRC management among NCAA student-athletes.