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Abstract
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Traumatic brain injury (TBI) is a serious public health concern, resulting in significant morbidity and mortality for thousands of people each year.1 More than 85% of TBIs are classified as mild and usually result from sport-related impacts.2,3 Sport-related concussion (SRC), a mild TBI induced by biomechanical forces, has the potential to cause acute and chronic neuropathologic changes, as well as clinical symptoms such as behavioral changes, cognitive impairment, and sleep disturbance.4 The relationships between SRCs and epidemiologic factors (eg, race, socioeconomic status) are beginning to emerge.
CASE
Two 15-year-old football players from opposing teams are involved in a head-to-head collision during a game. One player is African American; the other is Caucasian. They both immediately develop symptoms consistent with a concussion. The Caucasian athlete reports his symptoms to his athletic trainer and is removed from the game. The African American athlete shakes it off and plays the rest of the game with continued symptoms. Why the discrepancy?
In 2017, the Centers for Disease Control and Prevention (CDC) released an analysis of data from the national Youth Risk Behavior Survey, a biennial survey of 14,765 students in grades 9 to 12.5 An increased prevalence of concussions among male students compared to female students was noted. Across all racial and ethnic subgroups, youth athletes who were involved in multiple sports were more likely to report concussions. The CDC recommended focused efforts on educating youth athletes regarding the risks of concussions, regardless of the risk of concussion in a particular sport.5
The few studies that delineate the relationship between SRC and racial disparities focus on the adolescent athlete.6,7 African Americans comprise the majority of underserved, low-income student athletes in urban communities across the United States. Commonly, their schools lack access to health care professionals, especially licensed athletic trainers, who can provide concussion education and management, neuropsychologic baseline testing, and appropriate recommendations for returning to play after concussion. Illustrating the consequences of the lack of resources, a 2018 study found that African American adolescent athletes exhibited less concussion knowledge and were less likely to recognize concussion symptoms compared to Caucasian athletes.6 The study demonstrated that student athletes with access to licensed athletic trainers had greater concussion knowledge than athletes without access to trainers.6 Research suggests a greater risk of neurocognitive impairment following SRC in African American athletes.8
The finding that African American athletes have less knowledge about head injuries than Caucasian athletes aligns with evidence found in a retrospective, cross-sectional analysis of emergency department (ED) visits from the National Electronic Injury Surveillance System for the period 2008 to 2017. Of the 11,529,994 injuries for pediatric sport-related injuries, 13% were injuries to the head, and 5.4% of those patients were diagnosed with SRC.9 African American patients were less likely than Caucasian patients to have ED visits for head injuries or concussions and were less likely to be diagnosed with a concussion during an ED visit ...
Language: en |