Trends in sports-related concussion diagnoses in the USA: a population-based analysis using a private-payor database

Objective: To describe recent epidemiological trends in concussion diagnosis within the United States (US) population. Methods: We conducted a retrospective review of PearlDiver, a private-payor insurance database. Our search included International Classification of Disease, Ninth Revision codes for sports-related concussions spanning 2010 through 2014. Overall study population included patients aged 5 to 39 with subgroup analysis performed on Cohort A (Youth), children and adolescents aged 5 to 19, and Cohort B (Adults), adults aged 20 to 39. Incidence was defined as the number of individuals diagnosed normalized to the number of patients in the database for each demographic. Results: Our search returned 1,599 patients diagnosed during the study period. The average (+/- SD) annual rate was 4.14 +/- 1.42 per 100,000 patients for the overall population. Youth patients were diagnosed at a mean annual rate of 3.78 +/- 1.30 versus 0.36 +/- 0.16 per 100,000 in Adults. Concussion normalized incidence significantly increased from 2.47 to 3.87 per 100,000 patients (57%) in the Youth cohort (p = 0.048). In Adults, rate grew from 0.34 to 0.44 per 100,000 patients (29%) but was not statistically significant (p = 0.077). Four-year compound annual growth rates for Youth and Adults were 26.3% and 20.4%, respectively. Youth patients comprised 1,422/1,599 (90.18%) of all concussion diagnoses and were predominantly male (75%). Adults also constituted 138/1,599 (8.63%) of the sample and were also largely male (80%). Midwestern states had highest diagnostic rates (Cohort A: 19 per 100,000 and Cohort B: 1.8 per 100,000). Both cohorts had the most total diagnoses made in the fourth quarter followed by the second quarter. Conclusion: Sports-related concussion diagnostic rates have grown significantly in the youth population. Quarterly, regional and gender distributions appear consistent with participation in concussion-prone sports. Utilization of individualized and multifaceted approaches are recommended to advance diagnosis, assessment and management of concussions in the U.S. population.