{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:04:15Z","timestamp":1784160255939,"version":"3.55.0"},"reference-count":94,"publisher":"SAGE Publications","issue":"15-16","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["FDN143304"],"award-info":[{"award-number":["FDN143304"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>\n                    Social determinants of health (SDoH) are the non-medical factors that influence an individual\u2019s health and well-being. This study aimed to examine the relationships between SDoH and post-concussion symptom severity in Canadian children. We conducted a secondary analysis of data collected through Advancing Concussion Assessment in Pediatrics (A-CAP), a prospective longitudinal cohort study. Children aged 8\u201316 years with concussion (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 633) or orthopedic injury (OI;\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 334) were recruited from five Canadian pediatric emergency departments. Post-concussion symptoms were rated by children and parents using the Health and Behavior Inventory. Linear mixed-effects models assessed the associations of SDoH (i.e., race, household income, parental education, insurance status, neighborhood deprivation) and their interactions with time with post-concussion symptom severity. The cumulative impact of all SDoH was assessed with negative binomial generalized linear models at 3 months post-injury. In the linear mixed-effects models, race and education were significant predictors of both child-reported, race:\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (5, 1390.37) = 2.27,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.05; education:\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (3, 1155.55) = 3.14,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.03, and parent-reported somatic symptoms, race:\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (5, 2562.35) = 2.93,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.01; education:\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (3, 787.22) = 3.28,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.02. Joint tests of race,\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (15, 804.38) = 2.12,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.008, and neighborhood deprivation,\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (3, 379.12) = 2.74,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.04, and their interactions with time variables were statistically significant for parent-reported somatic symptoms. In the negative binomial generalized linear models, SDoH cumulatively contributed to the prediction of symptoms at 3 months post-injury over and above injury type (concussion vs. OI) and known prognostic factors (5P risk score) for child-reported cognitive,\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (17, 1154.75) = 1.94,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.012, and somatic,\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (17, 322.81 = 2.11,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.007, symptoms and parent-reported somatic symptoms,\n                    <jats:italic toggle=\"yes\">F<\/jats:italic>\n                    (17, 327.15) = 1.93,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.015. In summary, individual SDoH had small associations with symptoms after concussion in Canadian children, but the cumulative effects of multiple SDoH are likely an important factor in post-concussion symptom severity.\n                  <\/jats:p>","DOI":"10.1177\/08977151251407651","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T07:48:39Z","timestamp":1767772119000},"page":"1295-1312","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Social Determinants of Health and Symptomatic Recovery from Pediatric Concussion"],"prefix":"10.1177","volume":"43","author":[{"given":"Brian C.","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith Owen","family":"Yeates","sequence":"additional","affiliation":[{"name":"Department of Psychology, Alberta Children\u2019s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Tang","sequence":"additional","affiliation":[{"name":"Independent Consultant, Richmond, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam H.","family":"Beauchamp","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e9 de Montreal, Montreal, Canada."},{"name":"Ste-Justine Hospital Azrieli Research Center, Montreal, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, Canada."},{"name":"Stollery Children\u2019s Hospital, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh","family":"Doan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of British Columbia, Vancouver, Canada."},{"name":"BC Children\u2019s Hospital Research Institute, Vancouver, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Gravel","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine Department, Hospital Sainte-Justine, Montreal, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amori Yee","family":"Mikami","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Ramsay","sequence":"additional","affiliation":[{"name":"School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada."},{"name":"Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada."},{"name":"Children\u2019s Hospital of Eastern Ontario, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah D.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, Canada."},{"name":"Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada."},{"name":"Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617710000986"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-199908000-00005"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.03.039"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097729"},{"key":"e_1_3_2_6_2","unstructured":"Social Determinants of Health at CDC. 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