Study looks at concussion nondisclosure in college athletes from health disparities and social health determinants framework

By Sam Kanny. This article was initially published in our Concussion Update newsletter; please consider subscribing.

The Journal of Athletic Training recently published a research article entitled “Examining Concussion Nondisclosure in Collegiate Athletes Using a Health Disparities Framework and Consideration of Social Determinants of Health.” This study aimed to investigate “examing factors that may influence concussion nondisclosure in college athletes using a health disparities framework and consideration of social determinants of health.”

The study authors investigated whether concussion nondisclosure disparities existed by race, socioeconomic status (SES), or athletic training health care access before college. One of the study’s goals was to understand the differential reasons for concussion nondisclosure between White and Black collegiate athletes. 

Researchers found no differences in the incidence of concussion nondisclosure when comparing athletes by race. There was also no significant association between concussion nondisclosure and socioeconomic status or high school athletic training access. Despite these findings, researchers noted that “differences by race for reported reasons for nondisclosure were present for the statements, ‘At the time, I did not think it was a concussion’ and ‘I thought my teammates would think I am weak,’ with Black athletes selecting these more frequently than White athletes.” Also, the authors found that females were less likely to have a history of reporting a concussion.

The Health Disparities Framework and Social Determinants of Health are methods used by researchers to examine how social factors directly or indirectly influence an individual’s experience in healthcare and allow researchers to better understand why particular health outcomes are occurring in different populations. This study filled an existing gap in the literature and found no association between race and nondisclosure using the Health Disparities Framework and Social Determinants of Health models.

It is crucial to consider the sample population used in this study. The authors surveyed 735 collegiate athletes (from Division I, II, and III sports), 84.6% White and 15.4% Black. To account for the uneven distribution of race, researchers looked in-depth at first-year college athletes because there was a similar proportion across races. One social factor that stuck out to researchers was that Black athletes reported a higher proportion of having a history of free or reduced-price lunch (FRL) in high school. This finding may illustrate a disparity between White and Black athletes before arrival at college that could impact concussion-related outcomes and nondisclosure in high school. The conclusions of this study could indicate that at a collegiate level in sport, access to resources is more evenly dispersed to different races than at a high school level. Therefore, collegiate athletics may be a way to provide Black athletes access to equitable health care resources that they may have lacked access to before their collegiate athletic careers.