Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis.

CONTEXT

The incidence of sports-related concussion in females has been increasing in recent years.

OBJECTIVE

To conduct a meta-analysis on sex-based differences in concussion incidence in various sports and to determine the effects of study design (retrospective vs prospective), setting (competition vs practice), and population (university and above vs high school and below) via a meta-regression.

DATA SOURCES

PubMed (Medline), EMBASE, and Cochrane Library databases were searched from January 2000 to January 2018.

STUDY SELECTION

Studies reporting sports-related concussion incidence data for both males and females (age ≥10 years) were included.

STUDY DESIGN

Systematic review with meta-analysis and meta-regression.

LEVEL OF EVIDENCE

Level 4.

METHODS

The rate ratio was calculated as the concussion rate in females/males. Data were pooled using the DerSimonian-Laird random-effects model.

RESULTS

Thirty-eight studies met the eligibility criteria and were included in the meta-analysis. Soccer and basketball demonstrated significantly higher incidence of concussions in females compared with males (rate ratio [95% CI], 1.76 [1.43-2.16] and 1.99 [1.56-2.54], respectively; < 0.01). Sex-based differences in concussion incidence rates for baseball/softball, ice hockey, lacrosse, swimming/diving, and track and field were not statistically significant. In the meta-regression analysis, there were no significant effects on the rate ratio when evaluating study design, setting, and population.

CONCLUSION

Concussion incidence rates were significantly higher in females than in males for soccer and basketball.