Prosthetic Healthcare Deserts Across the United States

ABSTRACT Background Individuals with amputation require life-long access to prosthetic care for improving and maintaining function. One factor that influences access to prosthetic services is distance to providers. A nationwide analysis of prosthetic accessibility based on geographic information is needed to identify healthcare deserts across the United States. Objectives The aims of the study were to characterize the spatial distribution patterns of access to prosthetic services across the United States and to examine the impact of socioeconomic factors. Study Design Cross-sectional. Methods We computed the spatial distribution of demand for prosthetic services to locations of outpatient prosthetic clinics to estimate prosthetist provider to patient ratios (PPRs) in each Zip Code Tabulation Areas (ZCTAs) across the United States. Demand was estimated based on the number of adults with diabetes experiencing amputation. The likelihood that patients from a given ZCTA would seek services from a particular clinic was determined by comparing the distance between the patient ZCTA centroid and the clinic ZIP code. Global and local descriptive analyses were conducted with the ZCTA PPRs to characterize their relationships to socioeconomic factors. Results Prosthetic access generally follows overall population distributions, with higher PPRs in urban areas and in ZCTAs with higher demand. Accessibility also matches general patterns in healthcare access, with lower PPRs in areas overlapping with designated Health Professional Shortage Areas. Rural western states showed the lowest and scattered accessibility, reflecting a lack of Prosthetics and Orthotics education programs in this region. We found a concentration of ZCTAs with negative local correlations between access and the Black population, indicating a lack of access in certain southeastern areas. Conclusions Prosthetic healthcare deserts are more likely to be in western rural areas of the United States, with localized patterns influenced by socioeconomic factors. Clinical relevance To provide access to all patients with prosthetic care needs, prosthetic service and education providers should consider targeting the identified prosthetic healthcare deserts.