The Influence of Socioeconomic Status and Academic Standing on Concussion-Reporting Intentions and Behaviors in Collegiate Athletes

Concussion education have served as a keystone for improving concussion reporting. Numerous factors affecting concussion reporting have been explored; however, the role of socioeconomic status (SES) in reporting has not been established. We examined the influence of SES and academic achievement (high-school grade point average [HS-GPA] and American College Testing [ACT] composite scores) on athletes' concussion-reporting intentions and behaviors. A cross-sectional study was employed among 191 athletes (94 female; age 19.3 +/- 1.2 years). Athletes reported SES metrics (parental education and occupation, household income, HS-GPA, and ACT composite score) prior to their athletic season and completed a survey assessing symptom- and concussion-reporting intentions. Symptom- and concussion-reporting behaviors were assessed among athletes who experienced a concussion within the past year. SES was determined using the Hollingshead Four-Factor Index grouping athletes into SES strata. Athletes were grouped into low/high categories for academic achievement and household income variables. The 191 athletes were included for symptom- and concussion-reporting intentions analyses, while 46 and 41 were included for symptom- and concussion-reporting behavior, respectively. Nonparametric statistics with false discovery rate adjusted p values were employed. We found symptom- and concussion-reporting intentions, and symptom- and concussion-reporting behaviors were not significantly different based on SES strata (all p values >=.64), household income (all p values >=.64), HS-GPA (all p values >=.24), or ACT scores (all p values >=.25). Overall, SES and academic achievement may not play a role in understanding concussion reporting among middle- to high-SES collegiate athletes. Implementing policies targeting certain SES and academic levels might be an ineffective health care strategy for increasing reporting.