Characterize the impact of social health determinants on access to care and symptoms for youth with mTBIs.

There is growing awareness of the degree to which Social Determinants of Health (SDOH) – encapsulated by social identities and demographic variables – impact many aspects of healthcare outcomes, including concussion care and recovery, making it imperative to consider the impact on patients with historically marginalized gender, racial, linguistic, and ethnic identities.

Using retrospective data collected from the Four Corners Youth Consortium, we examined the impact of SDOH variables (e.g., race, ethnicity, insurance type, gender, age, and special educational services) on time to presentation (initial clinic contact), reported time to recovery, and symptom report (parent and child Post-Concussion Symptom Inventory [PCSI]) using multiple logistic regression and Cox proportional hazard regression statistical models.

Included participants (n = 702) represented a primarily White (68.3%), Non-Hispanic/Latinx (79.1%) sample that has access to insurance (82.3%) and does not receive special education (82.5%). Gender, neurodiversity (whether child receives special education services), race and insurance were significant predictors of symptom report and recovery. Female adolescents (b = 8.33, p < .001) and their parents (b = 6.57, p < .001) reported higher increases in overall post-injury symptoms, including greater changes in physical, cognitive, emotional and fatigue symptoms.

Neurodiverse (b = 1.07), p < .02), and Non-White (b_BIPOC = 0.75, b_other = 1.32; p < .05) children self-reported heightened symptoms of fatigue. Insured patients (HR = 1.5, p = .03) experienced faster recovery, while female participants (HR = 0.77, p = .025) experienced slower time to recovery.

Findings demonstrate that varying marginalized identities carry a higher symptom burden following a concussion, potentially facing more challenges for recovery. These findings reflect how social experiences related to privilege and marginalized status can ameliorate or compound the course of concussion symptomatology and recovery.