Max Hurwitz, DO, and Seattle Team Utilize VA Corporate Data Warehouse to Study Effects of Depression on Prosthesis Prescription in Men and Women Who Have Undergone Lower Limb Amputation
June 27, 2023
Max Hurwitz, DO, University of Pittsburgh Department of Physical Medicine and Rehabilitation – along with colleagues from VA Puget Sound Health Care System and the University of Washington in Seattle – published “The effect of depression on prosthesis prescription in men and women who have undergone a lower limb amputation” in Disability and Rehabilitation.
The goal of their study was to determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease.
The team conducted a retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis prescription rates and time to prescription between men and women veterans. The primary exposure was gender, and the primary outcome was a qualifying prosthesis prescription within 12 months of the incident amputation. The secondary outcome was time to prosthesis prescription. Multiple logistic and linear regression was used to control for potential confounders and identify potential effect modification.
A total of 2,862 individuals met study criteria, with 1690 (60%) prescribed a qualifying prosthesis. Men were more likely to receive a prosthesis prescription than women (59% versus 45%, respectively; p = 0.03). This difference was observed primarily among those with a diagnosis of major depressive disorder. In this subgroup, the odds of men receiving a prosthesis over women was over 3 times (adjusted odds ratio = 3.3; 95% Confidence Interval, 1.5, 7.4). Men had a mean shorter time to prescription compared to women (112 ± 72 versus 136 ± 79 days, respectively, p = 0.08).
This study shows that depression in women negatively impacts their prosthesis prescription rates and time to prescription compared to men. This disparity may have significant impacts on future function and quality of life. In the team’s analysis, men more commonly received a prosthesis prescription and received it earlier than women. This disparity was most extreme among women who had been diagnosed with major depressive disorder.
The team concluded that providers should identify at risk patients early and consider targeted interventions to address depression during the preoperative and immediate postoperative phases. Future research should continue to work to identify gender-specific needs that exacerbate disparity.
Read the full study.
Research team
Daniel Norvell
Aaron Turner
David Morgenroth
Alison Henderson
Elizabeth Halsne
Max Hurwitz
Joseph Czerniecki
