Roberts Anthony I, Resnik Linda J
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI; Rehabilitation Research & Development Service (RR&D), Providence VA Medical Center, Providence, RI.
Arch Phys Med Rehabil. 2025 May;106(5):667-673. doi: 10.1016/j.apmr.2024.12.001. Epub 2024 Dec 8.
To examine racial disparities in lower limb prosthesis (LLP) prescription practices between White and Black veterans across different geographic levels within the United States Veterans Health Administration (VHA) and explore how racial disparities in LLP prescription practices differ by amputation level.
Retrospective cohort study.
VHA facilities across the United States.
A total of 12,143 White and 4711 Black veterans who underwent major lower limb amputation between 2010 and 2022 in a VHA facility, including 4885 with transfemoral amputations (TFA) and 11,969 with transtibial amputations (TTA).
Not applicable.
Age-standardized percentage point (pp) differences in LLP prescriptions between White and Black veterans within 12 months post-amputation, analyzed at national, regional, and Veterans Integrated Service Network (VISN) levels. A positive pp difference indicates a racial disparity, meaning a higher proportion of White veterans were prescribed LLPs compared with Black veterans.
Nationally, 54.5% of veterans received an LLP prescription within 12 months post-amputation, with the age-standardized pp difference in LLP prescriptions favoring White veterans by 5.06 pp (95% confidence limits [CLs], 2.51,7.61). Regional analysis revealed variations, with the Continental region showing the largest disparity (9.10 pp; 95% CLs: 4.48, 13.71) and the Pacific region the smallest (3.27 pp; 95% CLs: -3.87,10.42). The VISN-level analysis uncovered greater variations, ranging from -9.26 to 14.54 pp. Disparities were more pronounced for veterans with TFA (5.25 pp; 95% CLs: 1.91, 8.59) compared with TTA (4.52 pp; 95% CLs: 1.54, 7.50).
Significant geographic variations exist in racial disparities for LLP prescriptions across the VHA, with most areas favoring White veterans. Disparities were more pronounced for veterans with transfemoral amputations, highlighting the need for targeted interventions to improve equity in access to prosthetic care, especially for veterans with more proximal amputations and in regions and VISNs with the largest disparities.
研究美国退伍军人健康管理局（VHA）内不同地理区域的白人和黑人退伍军人在下肢假肢（LLP）处方实践中的种族差异，并探讨LLP处方实践中的种族差异如何因截肢水平而异。
回顾性队列研究。
美国各地的VHA设施。
2010年至2022年期间在VHA设施接受主要下肢截肢的12143名白人和4711名黑人退伍军人，其中4885例为经股骨截肢（TFA），11969例为经胫骨截肢（TTA）。
不适用。
截肢后12个月内白人和黑人退伍军人在LLP处方方面的年龄标准化百分点（pp）差异，在国家、地区和退伍军人综合服务网络（VISN）层面进行分析。正的pp差异表明存在种族差异，即与黑人退伍军人相比，接受LLP处方的白人退伍军人比例更高。
在全国范围内，54.5%的退伍军人在截肢后12个月内接受了LLP处方，LLP处方的年龄标准化pp差异对白种退伍军人有利，为5.06个百分点（95%置信区间[CLs]，2.51,7.61）。区域分析显示存在差异，大陆地区差异最大（9.10个百分点；95%CLs：4.48,13.71），太平洋地区差异最小（3.27个百分点；95%CLs：-3.87,10.42）。VISN层面的分析发现差异更大，范围从-9.26到14.54个百分点。与TTA退伍军人（4.52个百分点；95%CLs：1.54,7.50）相比，TFA退伍军人的差异更为明显（5.25个百分点；95%CLs：1.91,8.59）。
VHA内LLP处方的种族差异存在显著的地理差异，大多数地区对白种退伍军人有利。经股骨截肢的退伍军人差异更为明显，这突出表明需要有针对性的干预措施来改善假肢护理获取的公平性，特别是对于截肢部位更靠近近端的退伍军人以及差异最大的地区和VISN。
