Toronto, ON, July 11, 2025 — A new study finds socioeconomic disparities in rates of emergency department (ED) visits for concussion among children and youth.
Researchers from ICES, York University, Toronto Metropolitan University, and the University of Calgary found an increase in ED visits for concussion among all age groups prior to the pandemic, with the biggest increase among older children and teens (ages 10 to 19 years). However, children in the highest socioeconomic status group accounted for significantly more concussion-related ED visits than children in the lowest socioeconomic status group.
"These trends are concerning, and flag a potential issue of equity among youth who may not have access to the same protocols and support for concussion care that we see in higher income populations," says lead author Dr. Alison Macpherson, a professor in the School of Kinesiology and Health Science at York University and senior adjunct scientist at ICES.
The study, published in the BMJ journal Injury Prevention , analyzed data for all Ontario ED visits for children and adolescents (ages 0 – 19 years old) with a diagnosis of concussion between 2010 and 2020. Socioeconomic status was assessed using categories of household material deprivation, which includes low income, unemployment, single parent families, parents without a high school diploma, and living in dwellings in need of major repair. The data were analyzed by age and sex.
There was a rise in concussion-related ED visits for all age groups. The 10-14 and 15-19 age groups had the greatest increases, from 350 and 382 per 100,000 in 2010 to 737 and 872 per 100,000 in 2019, respectively.
Further, rates among children with the lowest socioeconomic status rose from 36.7 in 2010 to 43.3 in 2020, compared to 62.6 and 61.8 for children in the highest socioeconomic status group.
While a large proportion of concussions are related to sports, which may be inaccessible to children with lower socioeconomic status, the socioeconomic gradient remained in 2020 when most organized sports were put on hold due to the COVID-19 pandemic. It is unlikely that sport participation is the only reason for the differences and there may be systemic barriers to concussion diagnoses.
The researchers suggest that reasons for lower rates of emergency department use among children and youth from low socioeconomic populations could be children's distance to hospitals, lack of information about concussion, and language or cultural barriers.
This is one of the first large, population-based studies to reveal an association between socioeconomic status and emergency department visits for concussion, while also showing changes in concussion visits over time, analyzed by age and sex. One limitation is that concussions may have been underrepresented if children did not seek medical attention for their injury, or if they saw a family doctor or other health care provider instead of visiting the ED. The researchers note that further study is needed to understand the full scope of concussion-related healthcare utilization.
"It's important that policy-makers, school boards, and coaches and teachers are aware of the socioeconomic differences in concussion-related emergency visits, so that they consider equity when creating policies about concussion and when delivering concussion prevention programs," says senior author Dr. Linda Rothman, an associate professor for the School of Occupational and Public Health at Toronto Metropolitan University.
