Healthcare Navigation of Black and White Adolescents Following Sport-Related Concussion: A Path Towards Achieving Health Equity

Context: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. Objective: To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. Design: Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. Main Outcome Measures: Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. Results: Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). Conclusions: This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes

ObjectivesAmerican-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes.MethodsCollegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate acquired C-LVH in black versus white athletes controlling for playing position (linemen (LM) and non-linemen (NLM)), family income, body weight and blood pressure.ResultsAt baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048).ConclusionsIndependent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.

Exploring the outcomes and experiences of Black and White athletes following a sport-related concussion: a retrospective cohort study

OBJECTIVE Young American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race may influence the experience and outcome of SRC. The authors’ objective was to compare White and Black athletes’ recovery and subjective experiences after SRC. METHODS A retrospective study was performed using the Vanderbilt Sports Concussion registry. Self-reported White and Black young athletes (ages 12–23 years) who had been treated for SRC between 2012 and 2015 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data were collected by electronic medical record review and phone calls to athletes and parents or guardians. The primary outcomes were as follows: 1) days to symptom resolution (SR), 2) days to return to school, and changes in 3) any daily activity (binary) and 4) sport behavior (binary). Secondary outcomes were changes (more, unchanged, or less) in specific activities such as sleep, schoolwork, and television time, as well as equipment (binary) or playing style (more reckless, unchanged, or less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards models, and logistic regression were performed. RESULTS The final cohort included 247 student-athletes (36 Black, 211 White). Black athletes were male (78% vs 58%) more often than White athletes, but both races were similar in age, sport, and medical/family histories. Black athletes more frequently had public insurance (33.3% vs 5.7%) and lived in areas with a low median income (41.2% vs 26.6%). After adjusting for age, sex, concussion history, insurance status, and zip code median income, Black athletes reached an asymptomatic status (HR 1.497, 95% CI 1.014–2.209, p = 0.042) and returned to school earlier (HR 1.522, 95% CI 1.020–2.270, p = 0.040). Black athletes were less likely to report a change in any daily activity than White athletes (OR 0.368, 95% CI 0.136–0.996, p = 0.049). Changes in sport behavior were comparable between the groups. CONCLUSIONS Racial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached SR and return to school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

Accuracy of the 2017 international recommendations for clinicians who interpret adolescent athletes’ ECGs: a cohort study of 11 168 British white and black soccer players

AimTo investigate the accuracy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players.Methods11 168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram; 10 581 (95%) of the players were male and 10 163 (91%) were white. ECGs were retrospectively analysed according to (1) the 2010 European Society of Cardiology (ESC) recommendations, (2) Seattle criteria, (3) refined criteria and (4) the international recommendations for ECG interpretation in young athletes.ResultsThe ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.8%, respectively). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% vs 12.9%; Seattle: 5.9% vs 4.2%; refined: 3.8% vs 2.8%; international 3.6% vs 1.6%; p<0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria identified a lower number of abnormal ECGs—by 67%, 78% and 86%, respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%.ConclusionsThe 2017 international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes to detect serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent soccer players.

Male Athlete Representations in Men’s Magazines: A Study in Mediated Sport Stacking

This study examined 681 male athlete features in Details, Esquire, GQ, and Playboy across the first two decades of the 21st century. While White athletes accounted for 283 features and Black athletes 329, the former were featured in 35 of 43 sports observed, compared to just 14 for the latter. In fact, more than 80% of all features on Black athletes focused on basketball, football, and boxing. Latino athletes accounted for 52 of the 681 total features and represented 15 sports, one more than African Americans. Recognizing existing research, the study applies the term mediated sport stacking to the practice of limiting the Black athletic experience primarily to team sports, especially basketball. The article considers the implications of statistical patterns observed and also includes limitations and recommendations for future research.

Media Representations of Multiracial Athletes

There is a substantial body of research examining racialized narratives about Black and White athletes. However, there is an absence of literature that has specifically explored multiracial identities in the sport context. The purpose of the current study was to examine narratives constructed in the media when discussing the race(s) of multiracial athletes. Investigators conducted a qualitative media analysis using 68 online and print news articles that clearly identified athletes as multiracial. Findings indicated that sports journalists are susceptible to perpetuating certain racialized sport stereotypes when covering multiracial athletes. Media members should make an effort to be aware of an athlete’s racial identity and be mindful of not relying on racial stereotypes when writing about multiracial athletes.

Abstract 19575: Prevalence of Abnormal T-wave Inversions in European and American Athletes and its Association with Abnormal Echocardiogram

Background: Electrocardiographic (ECG) evaluation is one of the primary tools utilized to screen for increased risk of sudden cardiac death in athletes. Recent study by Sheikh et al. proposed a further refinement to the Seattle criteria, known as the refined criteria. The objective of this study was to compare the prevalence of abnormal T-wave inversions (TWI) using the refined criteria in an American and European cohort and to evaluate the association of abnormal TWI with abnormal echocardiogram in the American cohort. Methods: Collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography from 2004 to 2013. ECG analysis of 1755 athletes was performed to asses for TWI as outlined by the refined criteria. Subjects were further classified by race, gender and area of TWI on ECG and compared to 5505 European athletes. Results: Of the 1755 American athletes, 49% were males and 1.3% had abnormal TWI. European cohort included 79% males and 3.9% abnormal TWI. Higher prevalence of abnormal TWI were noted in black athletes compared to white athletes in the American cohort (2% and 1.1% respectively). European counterpart had similar findings with 6% of black athletes and 3.3% of white athletes having abnormal TWI. In the American cohort abnormal TWI were distributed unequally within the anterior, lateral and antero-lateral leads (30%, 4% and 65% respectively). Only one American athlete (3.5%) with abnormal TWI had an abnormal echocardiogram. Conclusion: Incorporation of ECG assessment has been proposed as part of the preparticipation screening of athletes in United States. Comparison of American and European athletes showed a 67% lower prevalence of abnormal TWI in the American athletes. Only one American athlete with abnormal TWI had an abnormal echocardiogram. We conclude that abnormal TWI alone has a weak association with an abnormal echocardiogram in American college athletes.