Concussion Care Disparities

This article is an excerpt from our Care Disparities resource on our website.

Bias in Medicine

Despite researchers aiming towards nonpartisan objectivity, medical science continues to be influenced by current and past societal power structures. It is crucial to recognize that US history is plagued with racial injustice that nurtured systemic racism, which still exists today. Learn more about systemic racism here. As a result of living in a society with systemic racism, we all unknowingly hold views based on stereotypes, known as implicit bias.

Recent studies on implicit bias and equitable healthcare reported in Health Affairs show that “racial and ethnic minorities and women are subject to less accurate diagnoses, curtailed treatment options, less pain management, and worse clinical outcomes.” When tackling treatment for concussion—a relatively new area of research and care, where resources are difficult to find for all individuals, it is imperative to aid individuals who are particularly vulnerable to the effects of current care disparities in health care.

Contents

• Racial Disparities
• Gender
• People with Impairments due to Concussion Symptoms
• Intersectionality and Resources

Racial Disparities

Although there are a few objective tests for concussions that are recently FDA-approved,?such as a test that tracks eye movement, only a few clinics have implemented such methods. Therefore, the majority of concussion diagnosis relies heavily on proper patient-doctor communication. In minority populations, concussions are even more challenging to diagnose because doctors may hold implicit biases and patients may face racial discrimination. As a result, discrimination and implicit bias lead to a miscommunication between the patient and medical professional, often leading to incorrect diagnoses.?

Diagnosis and Mechanisms of Injury

A recent?study?found that non-Hispanic Non-White adolescents who visit the emergency room (ER) have lower concussion diagnosis rates and are more likely to sustain a concussion through an assault than their non-Hispanic white counterparts.

• Black children are 34% less likely to receive a concussion diagnosis when compared to white children.
• On average, Black children visit the ER less than white children with a concussion.
• Amongst those who received a diagnosis, Black children are 3.8 times more likely to obtain a concussion from assault than from sports.

These statistics highlight significant discrepancies in concussion care received by Black patients compared to white patients. These discrepancies may exist because minority populations are?less likely to have access to medical facilities and Medicare/insurance?as a result of systemic racism. Accessibility to healthcare is a significant issue as concussions need to be diagnosed by medical professionals for patients to receive proper treatment. Furthermore, as mentioned before, discrimination and implicit bias also create barriers for minorities seeking concussion care.

Assault as a Mechanism of Injury

Another study?found that Black children are more likely to obtain concussions from assault than white children. However, this may be because medical practitioners are more likely to suspect assault for minority patients because of?racial stereotyping.?The study also found that sports-related concussions (SRC) and assault-related concussions (ARC) differ in initial signs and symptoms, such as ARC patients being more likely to report a “decline in grades.” There were also differences in the treatment received by ARC and SRC patients, with “ARC patients [receiving] less concussion-specific diagnostic evaluation.” These results are indicative of a need for more research on the subject.

When it comes to improving concussion diagnosis for Black and other people of color (BIPOC), it is difficult to break down the barriers created by years of systemic racism. Still, a good starting point would be to increase research into the relationship between race and concussion symptoms. For example, a?study?in?Applied Neuropsychology: Adult?found significant differences in the post-concussion symptoms presented in individuals with different racial identities. More research into the topic will allow medical providers to be more aware of the differences and thus increase accuracy in terms of diagnosis.?

Perhaps by more awareness, reducing implicit bias is essential to increase the rate of concussion diagnosis for racial minorities. Although most individuals are unaware of their own biases, educating medical providers about common biases and unlearning them is a good start.

Race and Concussion Education

Black athletes had significantly lower scores on a concussion symptom knowledge assessment than white athletes in a?study?conducted by researchers Wallace et al. published in?The Journal of Head Trauma Rehabilitation. Moreover, the researchers noted that Black athletes were less likely to identify “a variety of sleep, affective, somatic, and cognitive symptoms” for concussion.?

Primary education of concussion symptoms may make it easier for minorities to navigate concussion care. As mentioned before, minorities are less likely to receive concussion diagnoses and may face racial discrimination. Proper knowledge of the signs and symptoms of concussion can help minorities better advocate for themselves when facing systemic racism. However, it is crucial to recognize that discrimination is a systemic issue, and minorities should receive proper concussion care regardless of prior concussion education.

The study by Wallace et al. mentions that “16% fewer Black athletes gained concussion knowledge from school-based professionals...than white athletes”. This disparity is worrying, considering that most of the athletes participating in the study were at risk of a sports-related concussion in high school.?Another article?reports that Black athletes who had high school athletic trainers were more likely to have comprehensive concussion knowledge than those who did not have athletic trainers. Furthermore, a previous issue of the Concussion Alliance Newsletter (in the?Culture?section) reports that lower funded schools, with a majority BIPOC student body, are less likely to have athletic trainers.

The proper solution to achieve equity in concussion education is to identify institutions that lack adequate concussion modules and help those students learn more about concussions at a young age. This change will help bridge the gap in concussion knowledge at a fundamental level.

To continue reading this article, see our Care Disparities resource on our website.