The Social Determinants of Health in Pediatric Concussion: A Scoping Review.

Abstract

Introduction: In North America, concussions are a common injury in the pediatric population. Much of the research to date has focused on biological aspects of concussion. Consideration of psychological, social and ecological factors, specifically the social determinants of health (SDH), relevant to concussion is essential to advancing the field of pediatric concussion.

Objectives: Using the WHO Conceptual Framework for Action on the Social Determinants of Health, we performed a scoping review to (1) identify and describe the research areas studied in the literature on SDH and pediatric concussion, and (2) summarize the reported findings of the included studies.

Methods: A comprehensive search for peer-reviewed articles published between 2005 and 2025, was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review (PRISMA-ScR) guidelines. Selected studies were reviewed for descriptive analysis by two independent reviewers.

Results: In total, 26 studies were included in this scoping review and the topics of study were grouped into 3 main categories: (1) identification; (2) service access and utilization; and (3) outcomes. Lower socioeconomic status (SES), limited English proficiency, and housing instability were linked to a higher incidence of concussions. Non-White pediatric patients, those with public insurance, and rural residents were more likely to use emergency departments instead of specialized concussion services. Non-White participants often had shorter recovery times, while the connections between socioeconomic status, public school attendance, and recovery duration were inconsistent.

Conclusion: The findings illustrate current gaps in the literature and opportunities for actions to address SDH among children and adolescents to improve representation in concussion research, understand differences in concussion reporting and tracking and learn about and mitigate disparities in access to concussion care and treatment outcomes.