718 - Racial Disparities In Concussions Among High School Students in the United States, 2017-2021

Publication Number: 718.6366

Jonathan Elliott, Dayton Children's Hospital, Kettering, OH, United States; Timothy Crawford, Wright State University Boonshoft School of Medicine, Fairborn, OH, United States

Background: Concussions are a source of significant morbidity among children. Few studies have examined the relationship between race and concussion, and little is known about this relationship and its potential mechanisms.

Objective: This study seeks to determine if there is a relationship between race and concussion among high school students, explore potential moderators of the relationship, and examine the effect that the COVID-19 pandemic may have had.

Design/Methods: Youth Risk Behavior Survey (YRBS),a nationally representative survey of high school students in the United States which is conducted every two years, was used to conduct this analysis.. Data from 2017, 2019, and 2021 were used, and an ordinal logistic regression was performed. The primary outcome was number of concussions reported in the past year, and the primary predictor was racial/ethnic group. Covariates included age, sex, and number of sports teams played on. Results were trended over time, and in a combined data set utilizing all three years of data.

Results: There were a total of 37,779 weighted participants, with 5,169 having had at least one concussion. There was a significant association between race and concussion, with American Indian/Alaskan Native, Black, Native Hawaiian/Pacific Islander, and Multiple races - Hispanic students having higher odds of concussion compared to White students. Additionally, there are increasing odds of concussion with increased number of sports teams (Figure 1). Results varied by both age and number of sports teams the student played on. When limiting the analysis to only those students who played on at least one sports team, the relationship between race and concussion was not present (Figure 2). Over the years of analysis, racial disparities in concussions worsened, with American Indian/Alaskan Native and Native Hawaiian/Pacific Islander students seeing an increase in concussions while all other racial groups saw a decrease (Figure 3).

Conclusion(s): Overall, there is a significant relationship between race and concussion, and the effect is moderated by both age and number of sports teams played on. Given that the relationship is only present among students who did not play on an organized sports team, and disparities increased during the COVID-19 pandemic, when children were primarily at home, this raises the possibility that differences in the built environment (access to safety equipment, a safe place to play) may be a potential mechanism for this relationship. Further research could explore this and develop targeted interventions to begin to address these disparities.

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