Research Reports - Socioeconomic status and outcomes after sport-related concussion

J Neurosurg Pediatr. 2017 Mar 24:1-10. doi: 10.3171/2017.1.PEDS16611. [Epub ahead
of print]

Zuckerman SL(1,)(2), Zalneraitis BH(1), Totten DJ(1), Rubel KE(3), Kuhn AW(1),
Yengo-Kahn AM(1,)(2), Bonfield CM(1,)(2), Sills AK(1,)(2), Solomon GS(1,)(2).

OBJECTIVE A significant proportion of patients experience long-term symptoms
after sport-related concussion (SRC), and several factors have been associated
with this protracted recovery. Limited data exist on the role of socioeconomic
status (SES) on SRC outcomes. The objective in this study was to conduct a
preliminary investigation to determine the effect of SES on outcomes after SRC in
student-athletes treated at a regional sports concussion center. METHODS A
retrospective cohort study of 282 middle school, high school, and collegiate
student-athletes was conducted. An attempt was made to contact all patients seen
at a comprehensive SRC center between January 2012 and May 2015 for in-depth
interviews. Subsequent demographic data were collected. The SES was defined as
follows: cost of living percentile, median income percentile, percentage of
college graduates, percentage of homeowners, county type, and insurance status.
Outcomes after SRC were defined as follows: days of symptom duration, days of
missed school, and days of missed practice. Statistically controlled covariates
included sex, race, age, body mass index, concussion history, neuropsychiatric
history, and type of sport. RESULTS A total of 282 student-athletes consented and
were studied. The median age was 15.8 years (range 11.6-22.2 years) and 61.4% of
student-athletes were male. A previous concussion was incurred by 34.0% of
student-athletes. Football was the most common sport (32.3%), followed by soccer
(16.3%), and basketball (15.6%). The median symptom duration was 21 days (range
1-365 days); the median missed school days was 2 (range 0-90 days); and median
for days of missed practice was 10 (range 0-150 days). After multivariate Cox
regression analysis, no relationship between any of the 6 SES variables and
symptom duration or missed practice was seen. However, individuals with private
insurance had more missed days of school than those with public insurance (hazard
ratio 0.46, 95% CI 0.26-0.83, p = 0.009). CONCLUSIONS In a preliminary study of
middle school, high school, and collegiate student-athletes, SES had no impact on
the outcomes of symptom duration and missed practice. However, for individuals
with private insurance, the return to school was slower than for those with
public insurance. This pilot study reveals the complex relationship between SES
and SRC recovery, which demands further study with more accurate and validated
assessments of SES. 

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