http://societyofcorrectionalphysicians.org/
Posted on March 3,
2010 – Jail and
prison inmates are known to have a higher burden of infectious diseases,
substance use disorders and psychiatric illness than the general,
non-institutionalized population, but do they also have a higher burden
of other chronic medical conditions, such as hypertension, diabetes, and
asthma?
The absolute prevalence of chronic medical conditions among inmates
seems high. Over one third of inmates in federal prisons (39%), state
prisons (43%) and local jails (39%) reported a chronic medical condition,
as described in recent publications by Dr. Wilper and colleagues1 and
the Bureau of Justice Statistics.2 In
which conditions was the prevalence among inmates higher than the
general population? Since inmate populations and the general population
differ so much in age, gender, race, education, employment, marital
status and other factors known to impact health outcomes, are prevalence
differences solely due to these underlying factors?
To answer these questions, we sought to compare inmates and the general
population. Unfortunately, inmates are generally excluded from the large,
nationally representative surveys of health conducted in the United
States such as the National Health Interview Survey. These surveys
exclude individuals in the military and in institutions, including jails,
prisons and nursing homes; however, the Bureau of Justice Statistics
does include a few health-related questions in their national surveys of
jail and prison inmates. We used data from the responses to these
questions in the Bureau of Justice Statistics Surveys and the National
Health Interview Survey to compare the prevalence of chronic medical
conditions among jail inmates, prison inmates and the general population.
Our study, published in theJournal of Epidemiology and Community
Health,3 describes
the burden of major medical conditions in jail inmates, compares jail
inmates to prison inmates, and compares inmates to the general
population. We were limited to examining conditions for which there were
comparable data across the surveys: hypertension, obesity/overweight/underweight,
asthma, diabetes, cancer, cervical cancer in particular, arthritis, and
hepatitis (undifferentiated). We adjusted for age, gender, race,
education, employment, marital status, the USA as birthplace and alcohol
consumption. Our results and those of a related study we conducted on
gender differences among jail inmates4 form
the basis of our findings below.
Findings
What were the most common
chronic medical conditions among inmates?
As one would expect, the prevalence of chronic conditions among inmates
vary by age, but among 34 to 49 year old men and women in prison, the
leading condition was overweight, with a prevalence of 47% (Figure 1).
After overweight, the leading medical conditions were:
1) Hypertension (24.7%)
2) Obesity (24.7)
3) Arthritis (23.1%)
4) Asthma (13.9%)
5) Hepatitis (12.9%)
Of the conditions we examined, cancer was reported by 3.1% of 34-49 year
olds, and cervical cancer was reported by 6.3% of the women. In this age
group, underweight (0.4%), myocardial infarction (0.9%) and angina
(0.8%) were the least common conditions.
How did the prevalence of chronic medical conditions in inmates compare with the general population?
After adjustment for major confounders, jail and prison inmates had significantly higher adjusted odds of hypertension, asthma, arthritis, cervical cancer (for women), and hepatitis (data shown in Table 1 for jail inmates only). However, jail and prison inmates did not have increased odds of diabetes, angina or myocardial infarction. Obesity was less common among jail and prison inmates than the general population. Obesity was also less significantly less common among jail inmates than prison inmates.
Are there gender differences in chronic medical conditions?
We found important gender differences in chronic conditions which suggest that women are worse off than men in terms of chronic medical conditions. Among jail inmates, women reported a higher prevalence of all medical conditions than men, including cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis.4
Implications for Correctional Physicians:
Our findings suggest that jail
and prison inmates have a disproportionate burden of many chronic
medical conditions compared to the general population, including
hypertension, asthma, arthritis, cervical cancer and hepatitis. We found
no differences in diabetes and that obesity was less common among jail
and prison inmates. Differences in these conditions persist even after
accounting for the effects of several important differences between
inmates and the general population.
Our hope is that these results can be used to guide correctional health
providers and administrators to allocate limited resources towards early
detection and appropriate management of common chronic medical
conditions among inmates. Hypertension, cervical cancer, and hepatitis
could benefit from early detection and treatment. We also stress the
importance of appropriate, evidence-based management of chronic medical
conditions such as asthma and hypertension.
Cervical cancer and hepatitis warrant special attention. Inmates had a
several fold increase in the odds of each of these conditions compared
with the general population. Hepatitis was a catch-all term that could
have included viral or alcoholic hepatitis; future surveys could be more
specific. Efforts by correctional physicians to conduct cervical cancer
screening in women and to screen and treat hepatitis should be supported.
Correctional physicians should provide input into the development of
questions for national surveys of inmates that reflect their real data
needs and the resource allocation problems they face in day-to-day
practice. Furthermore, correctional physicians should advocate for
coordinated data collection on the medical problems of jail and prison
inmates. For instance, coordination of data collection efforts between
the Bureau of Justice Statistics and the National Health Interview
Survey could lead to improved data quality about the health problems of
this significant population. Correctional physicians should provide
quality care for chronic medical conditions among inmates and
participate in quality improvement efforts at the local and national
level. Appropriate management of many chronic conditions, such as asthma
and hypertension, will require coordinating health services during
incarceration, transition to the community and after release.5 We
need to advocate for health care policies and financing that support
these efforts at care coordination for chronic conditions.
For more details about the medical problems of jail and prison inmates,
the latest reports from the Bureau of Justice Statistics website
www.ojp.usdoj.gov/bjs and the references listed below are a good
starting place.
Dr. Binswanger is an SCP member and Assistant Professor at the University of Colorado Denver School of Medicine, Division of General Internal Medicine in Aurora, Colorado. Readers may contact her at ingrid.binswanger@uchsc.edu.
References
1. Wilper AP, Woolhandler S, Boyd JW, et al. The Health and Health Care
of US Prisoners: Results of a Nationwide Survey. Am J Public Health
2009;99:666-672.
2. Maruschak L. Bureau of Justice Statistics Special Report: Medical
Problems of Jail Inmates. Washington, DC: U.S. Department of Justice;
2006.
3. Binswanger IA, Krueger PM, Steiner JF. Prevalence of chronic medical
conditions among jail and prison inmates in the USA compared with the
general population. J Epidemiol Community Health 2009;63(11):912-9.
4. Binswanger IA, Merrill JO, Krueger PM, White MC, Booth RE, Elmore JG.
Gender Differences in Chronic Medical, Psychiatric, and
Substance-Dependence Disorders Among Jail Inmates. Am J Public Health
2009.
5. Binswanger IA, Wortzel HS. Treatment for individuals with HIV/AIDS
following release from prison. JAMA 2009;302(2):147; author reply 148.