Objective Racial health outcome disparities exist in the United States. We sought to explore the association between race and sport-related concussion (SRC) recovery, as well as its mediating/moderating factors.

Design Retrospective cohort study.

Setting Regional Sport-Concussion Center.

Participants Athletes 12–18 years diagnosed with SRC from 11/2017–20/2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded.

Assessment of Risk Factors The primary independent variable of interest was race, dichotomized as Black/White.

Outcome Measures The primary outcome was time to clinical recovery (days from injury until patient was either deemed recovered by an SRC provider or symptom score returned to baseline/zero).

Main Results A total of 389 (82%) White and 87 (18%) Black athletes were included. Black athletes more frequently reported no SRC history (83% vs. 67%, p=.006) and lower initial symptom burden (median total Post-Concussion Symptom Scale [PCSS] 11 vs. 23, p<.001) than White athletes. Black athletes achieved earlier clinical recovery (HR=1.35, 95%CI 1.03–1.77, p=.030), which remained significant (HR 1.32, 95%CI 1.00–1.73, p=.048) after adjusting for confounders associated with recovery but not with race (sex/psychiatric comorbidity/migraine comorbidity/late clinic presentation [>7 days]). A third model adding initial PCSS nullified the association between race/recovery HR=1.12, 95%CI 0.85–1.48, p=.410). Finally, adding prior concussion history further reduced this association (HR=1.01, 95%CI 0.77–134, p=.925).

Conclusions Black athletes achieved earlier clinical recovery following SRC, a difference explained by differences in initial symptom burden and self-reported concussion history. These crucial differences may stem from cultural/psychological/organic factors.