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

• Published in: Journal of athletic training Vol. 57; no. 4; pp. 352 - 359
• Main Authors: Wallace, Jessica, Hou, Brian Q, Hajdu, Katherine, Tang, Alan R, Grusky, Alan Z, Lee, Timothy, Zuckerman, Scott L, Yengo-Kahn, Aaron M
• Format: Journal Article
• Language: English
• Published: United States National Athletic Trainers Association 01-04-2022
• Subjects: Adolescent; Adolescents; Athletes; Athletic Coaches; Athletic Injuries - diagnosis; Brain Concussion - diagnosis; Community Relations; Concussion; Emergency medical care; Emergency medical services; Ethnic Groups; Health care access; Health disparities; Health Equity; Health Services; High Schools; Humans; Injuries; Low Income Groups; Medical Services; Medicine; Neuropsychology; Neurosurgery; Occupational Therapy; Orthopedics; Patients; Pediatrics; Race; Racial Bias; Racial differences; Racism; Records (Forms); Referral; Retrospective Studies; Secondary schools; Socioeconomic factors; Speech Therapy; Sports; Sports medicine; Teenagers; health care disparities; race; care pathways; mild traumatic brain injury
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-0330.21

Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. Not only may these differences stem from health inequities, but they can perpetuate disparities in care for SRCs.
To determine whether racial differences existed in the care pathway from injury to SRC clinic of adolescent athletes.
Retrospective cohort study.
Regional SRC center.
Of 582 total athletes, 96 (16.5%) Black and 486 (83.5%) White adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic.
Race was the defined exposure, dichotomized as Black or White. The 4 primary outcomes were (1) location of the first health system contact, (2) time from injury to the first health system contact, (3) time to the in-person SRC clinic visit, and (4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or was lost to follow-up.
Black and White athletes mostly presented directly to the SRC clinic (61.5% versus 62.3%) at a median (interquartile range) of 3 (1-5) and 4 (1-8) days, respectively (P = .821). Similar proportions of Black and White athletes also first presented to the emergency department (30.2% and 27.2%) at a median of 0 (0-1) versus 0 (0-1) days, respectively (P = .941). Black athletes more frequently had care transferred to their athletic trainer than White athletes (39.6% versus 29.6%) and less frequently established care (56.3% versus 64.0%), respectively; however, these differences were not statistically significant (P = .138). Loss to follow-up was uncommon among Black (4.2%) and White (6.4%) athletes alike.
Within an established SRC referral network and multidisciplinary clinic, no racial disparities were observed in how athletes were initially managed or ultimately presented to the SRC clinic despite racial differences in school type and insurance coverage. The SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.