Journal CME February 2025, Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from a dysvascular etiology in a veteran population-PM R - 2024 - Hurwitz - Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from

PM R - 2024 - Hurwitz - Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from

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The article explores racial disparities in prosthesis abandonment and mobility outcomes among veterans who have undergone their first major lower extremity amputation due to diabetes and/or peripheral artery disease (PAD). Conducted as a national cohort study using data from the Veterans Affairs Corporate Data Warehouse, the research included 357 participants who had either transtibial or transfemoral amputations. The study aimed to identify disparities in prosthesis use and mobility levels between non-Hispanic Black (NHB) and non-Hispanic White (NHW) veterans, focusing on the influence of factors like living location and major depressive disorder (MDD).<br /><br />Key findings indicate that NHB veterans, especially those living in rural areas and diagnosed with MDD, are more likely to abandon their prosthesis compared to NHW veterans. The odds of abandonment are significantly elevated among NHB individuals with MDD in rural settings. Meanwhile, NHB veterans living in urban areas showed significantly reduced advanced mobility outcomes regardless of their MDD status, compared to their NHW and Hispanic counterparts.<br /><br />The study underscores the complex interplay of race, location, mental health, and socioeconomic factors on health outcomes post-amputation. It highlights a need for targeted interventions to support rural NHB populations and improve access to prosthetic care and rehabilitation services, along with early screening and management of depression to support prosthesis use and mobility. The study emphasizes systemic healthcare inequities and suggests that structural changes are needed to address these disparities, such as the VA’s Mobile Prosthetic and Orthotic Care program aimed at reaching underserved areas. <br /><br />Overall, this research points to significant healthcare disparities among veteran amputees, stressing the influence of socioeconomic status and mental health on rehabilitation outcomes.

Keywords

racial disparities

prosthesis abandonment

veterans

lower extremity amputation

diabetes

peripheral artery disease

major depressive disorder

mobility outcomes

healthcare inequities

Veterans Affairs