The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review.

CONTEXT: Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery.

OBJECTIVE: This review examined previous research that examined the effect of SDoH on concussion recovery of athletes.

EVIDENCE ACQUISITION: CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms "concussion" AND "recovery," "youth, adolescent, teen and/or adult," and "social determinants of health" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide.

EVIDENCE SYNTHESIS: Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality.

CONCLUSION: Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.