Residential Environments and ACcess to Healthcare (REACH 1): exploring the relationship between food deserts and mobility outcomes in lower limb prosthesis users

The intersection of geographic and economic disadvantage in food deserts (FDs) creates substantial barriers to food access, particularly for individuals with mobility impairments. For lower limb prosthesis users residing in food deserts, these challenges may be intensified by socioeconomic disparities that affect access to prosthetic care, device type, and rehabilitation services. These factors collectively hinder mobility, further limiting the ability to navigate and overcome environmental constraints. This study aimed to examine the relationship between FD residency and mobility outcomes among lower limb prosthesis users. A retrospective cross-sectional analysis ( N = 45,685) was conducted, grouping participants by FD residency status. Demographic and prosthetic rehabilitation variables were compared using Student’s t-tests and Pearson’s Chi-square tests. Mobility, measured by the PLUS-M™ T-score, was analyzed as a continuous variable using two-way ANOVA and as a categorical variable using simple and multiple logistic regression. Significant differences were found between FD and non-FD (nFD) residents in prosthesis use, assistive device use, insurance coverage, and mobility outcomes. FD residents had an average PLUS-M™ T-score 1.15 points lower than nFD residents ( p < 0.001, d = 0,1, small effect) and were significantly less likely to achieve high mobility (PLUS-M ≥ 50). This disparity remained statistically significant after adjusting for demographic and clinical variables. This study highlights disparities in mobility among lower limb prosthesis users, emphasizing the intersection of FD residency, insurance coverage, and prosthetic rehabilitation access. These findings highlight a potential need for targeted interventions to address mobility limitations in socioeconomically disadvantaged environments.