Disparities in Physical Function in Upper Limb Amputation: Influence of Race and Veteran Status

OBJECTIVES: Previous studies have shown that Black US Veterans with upper limb amputation (ULA) experience greater disability than their White counterparts. Given the comprehensive amputation care system of the US Department of Veterans Affairs (VA), it is possible that Veteran status moderates these disparities and that they may be even greater in non-Veterans with ULA. This research aims to investigate racial disparities in physical function and evaluate whether Veteran status moderates the relationship between race and physical function.

METHODS: A cross-sectional telephone survey collected data on physical function via the Patient-Reported Outcomes Measurement Information System - Upper Extremity Amputation-specific measure (PROMIS-UE AMP) and Upper Extremity Functional Scale for Prosthesis Users (UEFS-P) One-handed and Two-handed task scales. Multivariable linear regression models of PROMIS-UE AMP and UEFS-P scores on race and Veteran status were fit, adjusting for covariates significant at p ≤ 0.2 in bivariate analyses by race. In separate models, interaction terms between race and Veteran status were included to assess possible moderation by Veteran status.

RESULTS: The study included 713 participants, 79% male, mean age 61.3 years, 75.4% Veterans, and 65.4% prosthesis users. The racial composition was 83.6% White, 9.1% Black, and 7.3% Other. Black participants reported significantly lower PROMIS 13-UE AMP (β: -5.1, 95% CI: -7.7 to -2.5) and UEFS-P Two-handed Task (β: -4.0, 95% CI: -7.3 to -0.8) scale scores. Black Veterans scored 7.6 points higher than Black non-Veterans in the UEFS-P Two-Handed Task Scale (p=0.059).

CONCLUSIONS: The study found that Black participants had worse self-reported physical function compared to their White counterparts but did not find strong evidence that being a Veteran moderated the association between race and physical function. Further research is needed to understand the reasons for these disparities and to inform targeted interventions to improve outcomes of amputation care.