Quantifying and Addressing Racial and Ethnic Disparities in Lower-Limb Prosthesis Prescriptions Among US Veterans.

IF 1.9 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Medical Care Pub Date : 2026-10-13 DOI:10.1097/MLR.0000000000002385

Anthony I Roberts, Andrew R Zullo, Amal N Trivedi, M Jason Highsmith, Linda J Resnik

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引用次数: 0

Abstract

Background: Black and Hispanic Veterans undergo lower-limb amputations at higher rates than White Veterans, yet it remains unclear whether they receive equitable access to prosthetic devices within the Veterans Health Administration (VHA).

Objective: To quantify racial and ethnic disparities in lower-limb prosthesis (LLP) prescriptions among Veterans and identify factors contributing to these disparities.

Research design: Retrospective cohort study using generalized Kitagawa-Oaxaca-Blinder decomposition and prescriptive disparity analysis with double/debiased machine learning.

Subjects: Veterans who underwent major lower-limb amputation within the VHA from 2010 to 2022 (n=16,157; 66.2% White, 27.4% Black, 6.4% Hispanic).

Measures: Prescription of any LLP and advanced LLP within 12 months postamputation.

Results: Black and Hispanic Veterans were 5.7 percentage points (pp) [95% confidence limits (CLs): 4.0, 7.5] and 5.6 pp (95% CLs: 2.4, 8.8) less likely than White Veterans to receive any LLP prescription, respectively. For advanced LLPs, disparities were 1.7 pp (95% CLs: 0.8, 2.6) for Black Veterans and 3.0 pp (95% CLs: 1.5, 4.5) for Hispanic Veterans. Facility-level factors explained 58.2% of the White-Black disparity in any LLP prescriptions. Measured factors fully explained the White-Black disparity in advanced LLP prescription, with preamputation clinical factors contributing most. Prescriptive analysis revealed that targeted quality improvement at facilities serving high proportions of Black Veterans could reduce disparities by 32.5%, while interventions addressing end-stage renal disease could reduce advanced LLP disparities by 33.6%.

Conclusions: Targeted resource allocation to facilities serving high proportions of racial and ethnic minority Veterans and integrated care pathways for Veterans with complex comorbidities represent actionable interventions for reducing prosthetic care inequities.

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量化和解决美国退伍军人下肢假体处方中的种族差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Care 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

3.30%

发文量

228

审稿时长

3-8 weeks

期刊介绍： Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.