Socioeconomic status and concussion recovery in young athletes

Socioeconomic status (SES) may be associated with time to return to play (RTP) after sport-related concussion (SRC), but the literature is limited and has yielded mixed results. The purpose of our study was to determine the association between SES and concussion recovery in high school and middle school athletes.

High school and middle school athletes from 24 schools in southeast Minnesota who sustained a SRC between 2020 and 2023 were included in this study. Data obtained for each concussion included date of injury and date of clearance to complete a RTP protocol. A validated measure of SES, HOUSES (HOUsing-based index of SES), was used to determine SES by pairing home addresses to publicly available property data. SES was divided into four quartiles determined for the region (Q1 = lowest SES quartile, Q4 = highest SES quartile). A negative-bimodal regression model was used to analyze the relationship between SES and RTP time.

A total of 132 athletes (mean age 15.9 ± 1.5 years, 75.0% male) were included in the study. Among the total cohort, median RTP time was 12.0 days. Within each HOUSES quartile, median RTP time was 16 days in Q1, 12 days in Q2, 13 days in Q3, and 11 days in Q4. After adjusting for sex, race, ethnicity, and prior diagnosis of migraines, attention deficit/hyperactivity disorder, learning disorder, and mood disorder, athletes were estimated to have 23.9% fewer recovery days for each 1-unit increase in HOUSES quartile (p < 0.001).

RTP time after concussion may be related to SES in young athletes, with higher SES associated with shorter RTP timelines.