Social Determinants of Health and Lifetime History of Parent-Reported Concussion in School-Aged Children and Adolescents in the United States
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Social determinants of health (SDoH) are environmental and socioeconomic factors that indirectly or directly influence health. This study examined whether SDoH that might relate to health literacy or access to health care are associated with lifetime history of parent-reported concussion in school-aged children and adolescents in the United States. We hypothesized that lower parental education, living in poverty, and speaking a language other than English as the primary language in the home would be associated with a lower lifetime history of concussion. Participants were parents or caregivers of 34,077 children and adolescents (ages 5-17) from the 2021 National Survey of Children's Health. SDoH variables included primary language spoken at home, family income, parental level of education, and current health insurance. Univariable analyses assessed the individual association of each SDoH variable with lifetime history of concussion. A multivariable logistic regression was used to assess the combined association of SDoH variables and other demographic predictors with lifetime concussion history. In the univariable models, male gender, older age, sports participation, and having current health care coverage were associated with a higher lifetime history of concussion. Hispanic/Latino ethnicity, primary language spoken at home other than English, lower level of parental education, living in poverty, and Black or Asian race were associated with lower lifetime history of concussion. In a multivariable model, significant independent predictors of lower lifetime concussion history were lower level of parental education, not speaking English as the primary language at home, and identifying as Black or Asian. It is possible that lower parental education, living in poverty, and speaking a language other than English as the primary language spoken are factors relating to lower concussion-related health literacy. Lower health literacy might contribute to families being less likely to (i) recognize the symptoms of concussion and (ii) seek medical evaluation for the injury.