Differences in Prosthetic Prescription Between Men and Women Veterans After Transtibial or Transfemoral Lower-Extremity Amputation: A Longitudinal Cohort Study (2005-2018)

Abstract: The objective was to evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors. Study design was a retrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases. The setting was VHA patients throughout the United States. For participants, the sample included 20,889 men and 324 women who had an incident transtibial or transfemoral amputation between 2005 and 2018. Interventions were not applicable. Main outcome measures were 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. Results were 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.