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Youth-Concussion Laws Led to Massive Increase in Concussion Treatment

The passage of youth-concussion laws led to a massive increase in medical treatment for concussions in recent years, but other factors also contributed to the trend, suggests a study published online in JAMA Pediatrics last week.

The study examined health-care utilization rates for concussions from Jan. 1, 2006, through June 30, 2012, in states with and without youth-concussion laws. The authors sought to compare the rates of treatment in states with and without such laws to determine how much of an effect the legislation had.

By the end of the 2011-12 school year—the end of the study period—35 states and the District of Columbia had youth-concussion laws on the books. (The other 15 states have since followed suit.) Among insured children between the ages of 12 and 18, 7.15 per 1,000 were treated for concussions in the 2008-09 school year, the last year before the passage of the nation's first youth-concussion law (in Washington state). In 2009-10, the rate of treated concussions rose to 8.49 per 1,000 children, and then jumped to 10.64 per 1,000 in 2010-11 and 13.27 per 1,000 in 2011-12.

According to the study, rates of treated concussion among children in that age group were rising by 9 percent annually before the enactment of the nation's first youth-concussion law. After 2009, states without laws experienced a 20.9 percent annual increase in treated concussion rates, and states with laws had an average of 13.1 percent higher rate of treated concussions than states without laws.

Here's a year-by-year look at the average rate of diagnosed concussions per 1,000 health-care enrollees in states with and without youth-concussion laws in effect:

 ConcussionRate-Laws.png

Overall, states with youth-concussion legislation experienced a 92 percent increase in health-care utilization for concussions between 2008-09 and 2011-12 among children ages 12-18. States without such laws experienced a 75 percent rise in that same time frame, according to the study.

"We estimate that slightly more than half (60 percent) the increase in states without laws in effect resulted from the continued trend of increase in health-care utilization established before the first law was passed," the authors conclude. "The sources leading to the remaining 40 percent increase in utilization above the prelegislative trend were not evaluated, but it is not unreasonable to believe that general media coverage of laws from other states and/or the injury in general played a role."

The authors cited a LexisNexis search of news articles from 2006 through 2012, noting articles containing the search terms "sports" AND "concussion" AND "athlete" experienced a six-fold increase during that time.

"There are two stories here," said Steven Broglio, the study's senior author and an associate professor at the University of Michigan School of Kinesiology and director of the NeuroSport Research Laboratory, in a statement. "First, the legislation works. The other story is that broad awareness of an injury has an equally important effect. We found large increases in states without legislation, showing that just general knowledge plays a huge part."

Image via JAMA Pediatrics.

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