Key result
Athletes from lower socioeconomic high schools experienced increased injury incidence during the 2020-2021 pandemic school year, negating the pre-pandemic association between higher income and increased injury risk.
Why the study?
It is unclear how the cessation of high school sport during the COVID-19 pandemic affected athlete injury incidence across different socioeconomic levels.
Does high school socioeconomic status affect athlete injury incidence during the COVID-19 pandemic compared to pre-pandemic?
Observational (n=171,008)
Yes
Does high school socioeconomic status affect athlete injury incidence during the COVID-19 pandemic compared to pre-pandemic?
Relative Risk: 1.1 (95% CI 0.8–1.6)
Athletes from lower socioeconomic high schools experienced a disproportionate increase in injury incidence when returning to sports during the COVID-19 pandemic.
May signal widening injury disparities during disruptions in lower-SES athletes; leaves open need for targeted mitigation trials.
Background: It is presently unclear how the cessation of high school sport has affected injury incidence at different socioeconomic levels. The COVID-19 pandemic may have disproportionately affected athletes of lower socioeconomic status, potentially increasing injury risk in this population. Purpose: To 1) Describe athlete injury incidence prior to and during the 2019-2020 and 2020-2021 school years in high school athletes by socioeconomic status; 2) Investigate the association between socioeconomic status and injury incidence in high school athletes. Study Design: Ecological Study. Methods: High schools were matched between the 2019-2020 and 2020-2021 school years. All athletes from all sports were included. High school socioeconomic status was determined by the school district median household income. Socioeconomic strata were defined as <$30,000, $30,000-50,000, $50,001-100,000, and >$100,000. Injury incidence proportion with 95% confidence interval (95% CI) was calculated for each academic year. Mixed effects negative binomial models with robust errors were performed to assess the association between the incidence proportion ratio and high school median household income. Six states and 176 high schools were included (2019-2020: 98,487 athletes; 2020-2021: 72,521 athletes). Results: Injury incidence increased in three of four socioeconomic strata during the 2020-2021 year (<$30,000: 2019-2020: 15.6 (13.1-18.1), 2020-2021: 26.3 (23.1-29.6); $30,000-50,000: 2019-2020: 7.8 (7.1-8.6), 2020-2021: 14.9 (13.8-15.9); $50,001-100,000: 2019-2020: 15.1 (14.7-15.4), 2020-2021: 21.3 (20.9-21.8); >$100,000: 2019-2020: 18.4 (18.1-18.8), 2020-2021: 17.3 (16.8-17.7)). An association was observed between injury incidence ratio and log median high school household income in 2019-2020 [1.6 (1.1-2.5)] but not 2020-2021 [1.1 (0.8-1.6)] school years. Conclusions: Athletes from lower socioeconomic high schools reported increased injury incidence compared to higher socioeconomic high schools during the 2020-2021 academic school year. These results highlight the increased COVID-19 pandemic vulnerability in athletes from lower socioeconomic high schools. High school sport stakeholders should consider how abrupt sport stoppage can affect lower socioeconomic athletes. Level of Evidence: 2.
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Bullock et al. (2022) conducted an observational in Athlete injuries (n=171,008). High school socioeconomic status (median household income) vs. Higher socioeconomic status was evaluated on Injury incidence ratio per unit increase in log median high school household income (2020-2021) (Incidence proportion ratio 1.1, 95% CI 0.8-1.6). Athletes from lower socioeconomic high schools experienced increased injury incidence during the 2020-2021 pandemic school year, negating the pre-pandemic association between higher income and increased injury risk.
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