September 08, 2020
healthcare with a criminal record: negative health outcomes for those involved in the criminal justice system
There are certain populations that require special care in research and in medicine. These vulnerable populations are children, the elderly, pregnant women, and the incarcerated. Vulnerable groups are considered at high risk for health complications or consent-altering pressures. Once prisoners are released, they are no longer protected under the "vulnerable populations" category. Does their health status really improve after being released from prison? Evidence suggests that their health could actually get much worse.
First, let us start with the overall risk of mortality among released inmates. Researchers in Washington measured the risk of death among newly released inmates throughout the state compared to the risk of average Washington residents. They identified 30,237 released inmates from 1999 to 2003 and observed 443 deaths within that timeframe. Medical information about health status, access to care, and cause of death were collected.
The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8).
Source: Release from Prison — A High Risk of Death for Former Inmates
Based on the data collected, former inmates had 3.5 times higher risk of death compared to other state residents. The risk was even highest within the first few weeks after release from prison.
A later study by the same researchers used the dataset of newly released inmates from Washington state prisons to further understand the most common causes of death among this population. This time, they identified 76,208 participants who had been released between 1999 and 2009. They used the National Death Index for information about the 2,462 deaths that occurred over the ten years.
Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009.
Opioids were the leading cause of death and were involved in 14.8% of all deaths. Interestingly, women were at a higher risk of overdose and opioid death compared to men. The other common causes of death were still significantly higher than the general population of Washington state.
In a more comprehensive study, researchers compared the health status of individuals on probation and not on probation. They collected 4 years of data from the National Survey of Drug Use and Health and identified 3,685 adults aged 18 to 49 years on probation and 132,839 other adult respondents. Information about their physical and mental health was analyzed along with demographic characteristics.
Those on probation were more likely to have a physical condition (adjusted odds ratio [AOR] = 1.3; 95% confidence interval [CI] = 1.2, 1.4), mental illness (AOR = 2.4; 95% CI = 2.1, 2.8), or substance use disorder (AOR = 4.2; 95% CI = 3.8, 4.5).
Source: Health Status and Health Care Utilization of US Adults Under Probation: 2015–2018
The survey revealed higher rates of poor physical health among those on probation. Physical conditions that were reported at higher rates in the probation group include heart conditions, hepatitis B or C, HIV, kidney disease, and STIs. Mental conditions that were present at significantly higher rates in the probation group include major depression, illicit drug use disorder, and alcohol use disorder.
Those on probation were more likely to have a physical condition (adjusted odds ratio [AOR] = 1.3; 95% confidence interval [CI] = 1.2, 1.4), mental illness (AOR = 2.4; 95% CI = 2.1, 2.8), or substance use disorder (AOR = 4.2; 95% CI = 3.8, 4.5).
Understanding why former inmates report poorer health outcomes is immensely complicated. Initially, we must consider the directionality of this association. Were inmates in poor health before going to prison, did they get sick in prison, or did they develop health conditions after being released from prison? Answers to these questions would require a much longer study period that followed people prospectively before, during, and after their time in the criminal justice system.
