Disparities in Pediatric Concussion Outcomes and Family Burden by Neighborhood Opportunity

Mild traumatic brain injury (mTBI) is a common cause for pediatric emergency department visits and can impose substantial burdens on families, including missed work and childcare needs. Socioeconomic context may influence both healthcare use and these downstream impacts. This study examined the association between Child Opportunity Index (COI), a neighborhood-level measure of socioeconomic status, and healthcare utilization and indirect costs following pediatric concussion. In a secondary analysis of a multisite randomized controlled trial of patients with acute (<72 h) concussion, participants were categorized into high, middle, and low COI groups. Outcomes included follow-up care, caregiver missed workdays, childcare needs, and indirect costs, analyzed using multivariable regression models. Participants from lower COI neighborhoods were more likely to present to the emergency department, with 93.02% compared to 71.43% in higher COI groups (p = 0.005); had higher symptom scores at 14 days, 28.69 versus 16.64 (p = 0.03); and were less likely to be seen by concussion specialists, 6.98% versus 28.57% (p = 0.005). They also had lower odds of attending follow-up within 14 days (OR = 0.36, p = 0.015) and higher caregiver burden, including more missed workdays and childcare needs. Although total indirect costs did not differ significantly for low COI groups after adjustment, middle COI participants had lower costs than high COI ones. Overall, disparities were observed in care patterns and caregiver burden despite similar recovery outcomes. These findings suggest that expanding access to affordable concussion follow-up through school-based programs, telehealth services, transportation assistance, and flexible scheduling may help reduce caregiver burden and improve continuity of care for children from lower COI neighborhoods following pediatric mTBI.