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Abstract

Objective: To examine the relationships between social determinants of health (SDoH) and concussion outcomes in Canadian children. Methods: Secondary analysis of data collected through Advancing Concussion Assessment in Pediatrics (A-CAP), a prospective longitudinal cohort study. Children aged 8 to 16 with concussion (n=633) or orthopedic injury (OI; n=334) were recruited from 5 Canadian pediatric emergency departments. Post-concussion symptoms were measured with the Health and Behavior Inventory weekly for 3 months and biweekly from 3 to 6 months post-injury. Associations between SDoH (i.e., race, household income, parental education, insurance status, neighborhood deprivation) and their interactions with time and post-concussion symptom severity were assessed with linear mixed-effects models. Interactions between household-level and neighborhood-level SDoH and the joint impact of all SDoH were assessed with generalized linear models at 3-months post-injury. Results: Individual SDoH (race, parental education, neighborhood deprivation but not household income or insurance status) were associated with modest differences in post-injury somatic symptom reporting. Similar but weaker (and not statistically significant) patterns were observed for child- and parent- reported cognitive symptoms. Considering all SDoH together contributed to the prediction of injury outcome over and above injury type (concussion vs OI) and known prognostic factors (5P risk score) for three (child-reported cognitive and somatic and parent-reported somatic symptoms) out of the four outcomes at 3-months post-injury. The hypothesis that household and neighborhood metrics of SDoH interact, such that neighborhood deprivation only impacts post-concussion outcomes for children from disadvantaged households, was not supported. Conclusions: Individual SDoH may subtly influence recovery following concussion in Canadian children, but the joint impact of multiple SDoH likely has a stronger effect on recovery.