Abstract
Objective
To evaluate whether prosthetic prescription differed by gender and the extent to which
differences were mediated by measured factors.
Design
Retrospective longitudinal cohort study using data from Veterans Health Administration
(VHA) administrative databases.
Setting
VHA patients throughout the United States.
Participants
The sample included 20,889 men and 324 women who had an incident transtibial or transfemoral
amputation between 2005 and 2018.
Interventions
Not applicable.
Main Outcome Measures
Time to prosthetic prescription (up to one year). We used parametric survival analysis
(an accelerated failure time [AFT] model) to assess gender differences. We estimated
mediation effects of amputation level, pain comorbidity burden, medical comorbidities,
depression, and marital status on time to prescription.
Results
In the 1 year after amputation, the proportion of women (54.3%) and men (55.7%) prescribed
a prosthesis was similar. However, after controlling for age, race, ethnicity, enrollment
priority, VHA region, and service-connected disability, the time to prosthetic prescription
was significantly faster among men compared to women (Acceleration factor= 0.71, 95%
CI 0.60-0.86). The difference in time to prosthetic prescription between men and women
was significantly mediated by amputation level (19%), pain comorbidity burden (-13%),
and marital status (5%), but not medical comorbidities or depression.
Conclusion
Though the proportion of patients with prosthetic prescription at 1-year post-amputation
was similar between men and women, women received prosthetic prescriptions more slowly
than men, suggesting that more work is needed to understand barriers to timely prosthetic
prescriptions among women, and how to intervene to reduce those barriers.
Key words
List of abbreviations:
AF (Acceleration factor), AFT (Accelerated failure time), CDW (Corporate Data Warehouse), FY (Fiscal Year), HCPCS (Healthcare Common Procedure Coding System), ICD (International Classification of Diseases), LEA (Lower extremity amputation), MICE (Multiple Imputation by Chained Equations), TFA (Transfemoral amputation), TTA (Transtibial amputation), VHA (Veterans Health Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 20,
2023
Received in revised form:
January 26,
2023
Received:
June 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Acknowledgements
This material has not been previously presented. This material is based upon work supported by the Department of Veterans Affairs through a Rehabilitation R&D Merit grant (I01RX002797, Co-PIs Littman and Lehavot). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
The authors have no conflicts of interest to report.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
