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Sports-related concussion (SRC) is a substantial concern in collegiate athletics. Some studies of SRC that make comparisons by sex are limited by sample size, follow-up duration, or referral bias. Sex-specific predictors of occurrence and recovery are uncertain.A 15-year retrospective cohort study identified 1,200 Columbia University varsity athletes (822 male [68.5%], 378 female [31.5%]) at risk of collegiate SRC.A total of 228 athletes experienced at least one collegiate concussion, including 88 female athletes (23.3% of female athletes) and 140 male athletes (17.0% of male athletes) (P = 0.01); follow-up data were available on 97.8% of these athletes. Postconcussion symptoms were similar by sex, with the exception of sleep disturbance (29.3% of male athletes versus 42.0% of female athletes; P = 0.048) and memory impairment (43.6% of male athletes versus 30.7% of female athletes; P = 0.052), although the latter difference was not statistically significant. Risk factors for collegiate concussion included female sex (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1 to 2.0) or precollegiate concussion (OR, 2.9; 95% CI, 2.2 to 3.9). Prolonged recovery was predicted by the presence of eight or more postconcussion symptoms for all athletes (OR, 3.77; 95% CI, 1.68 to 8.46) and for female athletes only (OR, 8.24; 95% CI, 1.58 to 43.0); this finding was not statistically significant for male athletes.Female athletes were more likely than male athletes to experience concussion. Increasing numbers of prior concussions predicted recurrence. Although most postconcussion symptoms were highly intercorrelated, the total number of symptoms predicted a prolonged recovery period.This study confirms sex-based differences in SRCs. Longitudinal studies of collegiate cohorts should attempt to limit follow-up bias and offer opportunities to clarify determinants of SRC.