Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA.
Arch Phys Med Rehabil. 2023 Aug;104(8):1274-1281. doi: 10.1016/j.apmr.2023.02.011. Epub 2023 Mar 9.
To evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors.
Retrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases.
VHA patients throughout the United States.
The sample included 20,889 men and 324 women who had an incident transtibial or transfemoral amputation between 2005 and 2018.
Not applicable.
Time to prosthetic prescription (up to 1 year). We used parametric survival analysis (an accelerated failure time 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.
In the 1 year after amputation, the proportion of women (54.3%) and men (55.7%) prescribed a prosthesis was similar. However, after we controlled for age, race, ethnicity, enrollment priority, VHA region, and service-connected disability, the time to prosthetic prescription was significantly faster among men compared with women (acceleration factor=0.73; 95% confidence interval, 0.61-0.87). The difference in time to prosthetic prescription between men and women was significantly mediated by amputation level (23%), pain comorbidity burden (-14%), and marital status (5%) but not medical comorbidities or depression.
Although the proportion of patients with prosthetic prescription at 1-year postamputation 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.
评估假体处方是否因性别而异，以及这些差异在多大程度上受到测量因素的影响。
使用退伍军人健康管理局（VHA）行政数据库中的数据进行回顾性纵向队列研究。
美国各地的 VHA 患者。
该样本包括 20889 名男性和 324 名女性，他们在 2005 年至 2018 年间发生了胫骨或股骨间的创伤性截肢。
不适用。
假体处方的时间（最长 1 年）。我们使用参数生存分析（加速失效时间模型）来评估性别差异。我们估计了截肢水平、疼痛合并症负担、医疗合并症、抑郁和婚姻状况对处方时间的中介效应。
在截肢后 1 年内，女性（54.3%）和男性（55.7%）接受假体处方的比例相似。然而，在控制年龄、种族、民族、登记优先级、VHA 区域和与服务相关的残疾后，男性接受假体处方的时间明显快于女性（加速因子=0.73；95%置信区间，0.61-0.87）。男性和女性在接受假体处方的时间上的差异，通过截肢水平（23%）、疼痛合并症负担（-14%）和婚姻状况（5%）显著中介，但与医疗合并症或抑郁无关。
尽管男性和女性在截肢后 1 年接受假体处方的比例相似，但女性接受假体处方的速度比男性慢，这表明需要做更多的工作来了解女性及时接受假体处方的障碍，以及如何干预以减少这些障碍。
