Prior concussion history is posited to influence many outcomes. Understanding how concussion history affects quality of life may identify student-athletes needing intervention and those predisposed to other conditions. PURPOSE: To examine how prior concussion history influences college athletes’ pre-season baseline health-related quality life (HRQOL). METHODS: Student-athletes (n = 1599) from six Canadian and US college institutions and 24 college sports, completed a comprehensive concussion baseline assessment including an HRQOL evaluation (PROMIS-29, Neuro-QOL Fatigue, and Neuro-QOL Cognition Scales). The primary predictor was concussion history and covariates included age, sex, BMI, and contact sport participation. Primary outcomes were Anxiety, Physical Function, Depression, Sleep Disturbance, Social Role/Activities, Pain Interference, Pain Intensity, Cognition, and Neuro-related Fatigue raw scores. Linear regression models clustered on study site using generalized estimating equations examined the association between concussion history and HRQOL outcomes. RESULTS: Analysis was limited to 1509 (94%) participants with complete outcome and covariate data [538 females (35.6%); median age = 19 years (range: 18-27); 553 (36.7%) with 1+ prior concussions); 1154 (76.5%) played a contact sport]. Concussion history, adjusted for age, sex, BMI, and contact sport participation, were associated with greater anxiety, sleep disturbance, depressive feelings, fatigue, and worse cognition function. However, these differences were mostly minor. Clinically meaningful mean differences (MD) suggest those with multiple concussions report worse cognitive function (MD=-1.2; 95%CI: -2.4, -0.1 for 3+ vs 0 concussions; MD=-1.1, 95% CI:-2.3, 0.1 for 2 vs. 0 concussions) and greater neuro-related fatigue (MD=1.3, 95% CI: -0.1, 2.7 for 3+ vs 0 concussions; MD=0.9, 95% CI: 0.1, 1.7 for 2 vs 0 concussions). CONCLUSIONS: After controlling for covariates, these data suggest that following primary recovery, those with prior concussions may exhibit increased cognitive and fatigue related complaints. These residual effects may confound incident concussion assessments, particularly when pre-season baseline measures are not available. Supported in part by a grant from the National Football League