Past incarceration linked to worse health outcomes

Adults with a history of incarceration had a higher risk of developing chronic disease and geriatric syndromes than those who were never incarcerated, highlighting the need for targeted interventions, according to the researchers.

While previous research has established that incarcerated people face higher rates of geriatric syndromes and chronic illnesses, Ilana R. Garcia-Grossman, MD, a board-certified primary care internist and current veterans affairs fellow at the University of California, San Francisco, National Clinician Scholars Program, and colleagues wrote in JAMA network open that it is unclear whether older adults who have a history of imprisonment also face these risks.

“There is a profound lack of data on U.S. adults with criminal records,” the researchers wrote, adding that there is “a critical need for improved data collection and transparency to generate accurate estimates of life imprisonment in states united”

Garcia-Grossman and colleagues conducted a cross-sectional study to better understand the connections between incarceration history and health outcomes in later life. They used population-based data from 13,462 adults age 50 and older who completed the 2012 or 2014 Health and Retirement Study (HRS), which is a nationally representative survey.

Of the participants, 946 adults with a mean age of 62.4 years had been imprisoned, for a prevalence rate of 7.6%. Those with a history of imprisonment were more likely to be men – 83% vs 42.8% – in the lowest wealth quartile – 44.1% vs 21.4%.

“We found that at least one in 15 adults… experienced incarceration in their lifetime,” the researchers wrote. “This is likely an understatement of the actual experience of US seniors as HRS does not include people who were homeless, did not have a telephone or were incarcerated at the time of study enrollment.”

There were no associations between a history of incarceration and diabetes or cardiovascular conditions, but the researchers found a 20% to 80% increased risk for all geriatric syndromes, including hearing impairment (RR = 1.22; 95% CI, 1.04-1.44) and activities of daily living impairment (RR = 1.62; 95% CI, 1.4-1.88) after adjustment for age, gender, race and ethnicity, wealth, level of education and uninsured status.

“We found that health outcomes associated with a history of incarceration had a positive linear trend in our unadjusted analysis; Longer retention periods were associated with higher disease prevalence for many health outcomes,” Garcia-Grossman and colleagues wrote.

Additionally, prior incarceration was also linked to higher risks for certain chronic diseases, including:

• chronic lung disease (RR = 1.56; 95% CI, 1.27-1.91);
• heavy alcohol use (RR = 2.13; 95% CI, 1.59-2.84); And
• mental health conditions (RR = 1.8; 95% CI, 1.55-2.08).

“These findings are consistent with previous research demonstrating a high prevalence of chronic health conditions and geriatric syndromes at a relatively young age among older adults who were currently incarcerated (rather than living in the community) and support the notion of accelerated aging in this population”. Garcia-Grossman and colleagues wrote.

While the study was not intended to evaluate “the underlying causal pathways between incarceration and poor health,” the researchers did offer several potential explanations:

• people who experience incarceration could face worse underlying health that persists for life;
• facing incarceration could worsen poor health due to variable access to physical activity, healthy food and high-quality health care, or due to “exposure to trauma and violence, acute and chronic stress resulting from live in dehumanizing conditions”;
• incarceration can also lead to “downstream barriers to other social determinants of health,” such as housing and employment, which also contribute to worse health outcomes; And
• connections between incarceration and worse health outcomes may be “the result of unexplained confounders, suggesting the need for a longitudinal cohort study of people after release from incarceration.”

“Regardless of the underlying etiology, our findings support that a history of incarceration is an important indicator of risk for adverse health outcomes and therefore should be considered by physicians, public health professionals, and policy makers,” they wrote.

Policymakers and health care professionals should consider the health implications of incarceration for older adults, according to Garcia-Grossman and colleagues.

“Our findings indicate that incarceration is so prevalent in the United States that an older adult’s likelihood of having a history of incarceration is greater than their lifetime risk of developing colorectal cancer,” they wrote. “However, despite the ubiquity of criminal legal system involvement in the United States, there has been relatively little funding and research devoted to understanding the downstream health outcomes and needs of this population.”

The researchers also noted that evidence regarding the long-term health consequences of incarceration is critical as policymakers look at ways to “reduce the footprint of mass incarceration in the United States.”

“Given that incarceration is experienced differently by racial and ethnic minority individuals in the United States, more research is needed to evaluate whether involvement in the criminal legal system contributes to the health disparities observed in these populations,” they wrote. “Healthcare professionals can benefit from advanced training, for example, on the effects of incarceration on individuals and communities or on the existence and implications of accelerated aging in this population.”