Geographic Variation in Lower Limb Prosthesis Prescription Disparities Between White and Black Veterans: A Retrospective Cohort Analysis (2010 - 2022)
Author(s)
Anthony I. Roberts, MSc, Linda J. Resnik, PT, PhD;
Brown University School of Public Health, Health Services, Policy and Practice, Providence, RI, USA
Brown University School of Public Health, Health Services, Policy and Practice, Providence, RI, USA
OBJECTIVES: Lower limb prostheses (LLPs) are crucial for restoring function and facilitating community reintegration after amputation. While racial disparities in healthcare delivery within the Veterans Health Administration (VHA) are documented, the extent to which disparities in LLP prescription practices vary geographically remains largely unexplored. This study aimed to examine racial disparities in LLP prescriptions between White and Black Veterans across different geographic levels within the VHA and investigate how these disparities vary by amputation level.
METHODS: This retrospective cohort study included 12,143 White and 4,711 Black Veterans who underwent major lower limb amputation in VHA facilities between 2010 and 2022. The primary outcome was LLP prescription within 12 months post-amputation. Age-standardized percentage point (pp) differences in prescriptions between White and Black Veterans were calculated at national, regional, and Veterans Integrated Service Network (VISN) levels using the nonparametric g-formula. Cluster-robust standard errors were employed to account for correlations within VHA facilities and to estimate 95% confidence limits (CLs). Analyses were stratified by amputation level: transfemoral (TFA) and transtibial (TTA).
RESULTS: Overall, 54.5% of Veterans received an LLP prescription within 12 months post-amputation. The age-standardized difference in LLP prescriptions favored White Veterans by 5.06 pp (95% CLs: 2.51, 7.61) nationally. Regional analysis revealed substantial variation, with disparities ranging from 3.27 to 9.10 pp. VISN-level analysis uncovered even greater variations, ranging from -9.26 to 14.54 pp. Nationally, disparities were more pronounced for Veterans with TFA (5.25 pp; 95% CLs: 1.91, 8.59) compared to TTA (4.52 pp; 95% CLs: 1.54, 7.50).
CONCLUSIONS: Significant geographic variations exist in racial disparities for LLP prescriptions across the VHA, with most areas favoring White Veterans. These disparities were more pronounced for Veterans with transfemoral amputations, highlighting the need for targeted interventions to improve equity in post-amputation care, particularly in regions and VISNs with the largest disparities.
METHODS: This retrospective cohort study included 12,143 White and 4,711 Black Veterans who underwent major lower limb amputation in VHA facilities between 2010 and 2022. The primary outcome was LLP prescription within 12 months post-amputation. Age-standardized percentage point (pp) differences in prescriptions between White and Black Veterans were calculated at national, regional, and Veterans Integrated Service Network (VISN) levels using the nonparametric g-formula. Cluster-robust standard errors were employed to account for correlations within VHA facilities and to estimate 95% confidence limits (CLs). Analyses were stratified by amputation level: transfemoral (TFA) and transtibial (TTA).
RESULTS: Overall, 54.5% of Veterans received an LLP prescription within 12 months post-amputation. The age-standardized difference in LLP prescriptions favored White Veterans by 5.06 pp (95% CLs: 2.51, 7.61) nationally. Regional analysis revealed substantial variation, with disparities ranging from 3.27 to 9.10 pp. VISN-level analysis uncovered even greater variations, ranging from -9.26 to 14.54 pp. Nationally, disparities were more pronounced for Veterans with TFA (5.25 pp; 95% CLs: 1.91, 8.59) compared to TTA (4.52 pp; 95% CLs: 1.54, 7.50).
CONCLUSIONS: Significant geographic variations exist in racial disparities for LLP prescriptions across the VHA, with most areas favoring White Veterans. These disparities were more pronounced for Veterans with transfemoral amputations, highlighting the need for targeted interventions to improve equity in post-amputation care, particularly in regions and VISNs with the largest disparities.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD28
Topic
Health Service Delivery & Process of Care
Disease
SDC: Geriatrics, SDC: Injury & Trauma, STA: Multiple/Other Specialized Treatments