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Updated: Oct 2, 2025
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Disparities in concussion diagnoses compared to ankle injuries
William A Marmor1, Kathryn D McElheny1, Ryan J Lingor1
1Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.
Background:
Health disparities related to concussions have been reported in the literature for certain minority populations. Given the significant impact of concussions on long- and short-term function, the mitigation of barriers to accessing care is an important public health objective.
Objective:
To determine if racial and ethnic disparities exist in patients who seek care for concussions compared to a control group with orthopedic ankle injuries (sprains and fractures) to minimize confounding factors that predispose to injury.
Design:
Cohort study.
Setting:
Single institution between February 2016 and December 2020.
Patients:
A retrospective review of electronic medical records was completed for patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for concussion, ankle sprain, and ankle fracture. A total of 10,312 patients were identified: 1568 (15.2%) with concussion, 4871 (47.3%) with ankle sprain, and 3863 (37.5%) with ankle fracture.
Interventions:
Patients were stratified by demographic factors, including sex, ethnicity, race, and insurance type.
Main Outcome Measures:
Diagnosis of concussion.
Results:
The concussion group was the youngest (28.3 years ± 18.0) and had the fewest females (53.1%) compared to the ankle sprain (35.1 years ± 19.7; 58.7%) and fracture groups (44.1 years ± 21.3; 57.3%). The concussion group had a smaller proportion of Hispanic patients than the ankle sprain group (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.55-0.92, p = .010) and fracture group (OR 0.58, 95% CI 0.44-0.75, p = <.001). In addition, the concussion group was less likely to be Asian (OR 0.70, CI 0.52-0.95, p = .023) than the sprain group and less likely to be Black/African American than both sprain (OR 0.65, 95% CI 0.46-0.93, p = .017) and fracture groups (OR 0.62, 95% CI 0.43-0.89, p = .010). There were no differences across racial groups between ankle sprains and fractures. Patients with Medicaid/Medicare and self-pay had a higher likelihood of being in the concussion group than those with private insurance.
Conclusion:
Differences in concussion diagnosis may exist between certain demographic groups compared to those with ankle injuries. Efforts to mitigate disparities in concussion care are worthwhile with a focus on patient and caregiver education.
