The Disease Profile of Texas Prison Inmates

doi:10.1016/S1047-2797(99)00033-2

Annals of Epidemiology

Volume 10, Issue 2, February 2000, Pages 74-80

https://doi.org/10.1016/S1047-2797(99)00033-2 Get rights and content

Abstract

PURPOSE: Whereas prison inmates are reported to exhibit poorer overall health status and higher rates of health care utilization than the general population, no current information exists on the overall disease profile of the U.S. prison population. The present study examined the prevalence of major acute and chronic conditions in one of the nation's largest prison populations.

METHODS: The study population consisted of 170,215 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between August 1997 and July 1998. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system.

RESULTS: Infectious diseases (29.6%) constituted the most prevalent major disease category among inmates. This was followed by diseases of the musculoskeletal system and connective tissue (15.3%), diseases of the circulatory system (14.0%), mental disorders (10.8%), and diseases of the respiratory system (6.3%). Among the specific conditions examined, evidence of tuberculosis infection without active pulmonary disease (20.1%) was found to be the most prevalent condition, followed by hypertension (9.8%), asthma (5.2%), low back pain (5.1%), and viral hepatitis (5.0%).

CONCLUSIONS: The present study shows that for a number of conditions, the prison population exhibited prevalence rates that were substantially higher than those reported for the general population. Moreover, estimates for a number of diseases varied substantially according to age, race, and gender. Understanding the disease profile in U.S. incarcerated populations will permit correctional administrators to develop more efficient health care delivery systems for prison inmates.

Introduction

Research indicates that prison inmates in the United States exhibit higher rates of health care utilization than the general population 1, 2, 3, 4, 5. This excess has been attributed in part to prison inmates' increased risk for infectious disease 6, 7, 8, 9, 10 and mental disorders 10, 11, 12. The prevalence of both tuberculosis and hepatitis, for example, are reported to be higher for prisoners than for their same-age peers in the general population 10, 13. Likewise, the incidence of AIDS and a number of other sexually transmitted diseases are reported to be substantially elevated among prisoners 2, 7, 8, 9.

Prison inmates are also reported to exhibit elevated rates of affective disorders, schizophrenic disorders, and substance abuse 10, 11, 12. Scarce information exists, however, on the many other medical conditions that underlie the high health care utilization rates of prisoners. This dearth of information has hindered the organization of effective health care delivery in prison systems.

The purpose of the present investigation, therefore, was to examine the prevalence of major diseases, both infectious and chronic, in one of the nation's largest prison populations.

Section snippets

Methods

The cohort under study consisted of 170,215 prison inmates who were incarcerated in the Texas Department of Criminal Justice (TDCJ) system for any duration dating from August 1997 through July 1998. Texas houses one of the largest prison populations in the U.S. (11) and together with California houses almost one-third of all U.S. prison inmates (14). All inmates included in the present study population have been convicted of criminal offenses. Diagnoses of all medical conditions were made by

Results

Sociodemographic characteristics of the total TDCJ inmate population are presented in Table 1. The vast majority of inmates were male and between 30–49 years old. Blacks constituted 44% of the total inmate population, whereas Whites and Hispanics represented 30% and 26%, respectively. Prevalence estimates of all major ICD-10 categories in the TDCJ study population are presented overall and for males and females separately in Table 2.

Infectious diseases comprised the most common category of

Discussion

The purpose of the present study was to describe the patterns of disease prevalence in the TDCJ prison population. The findings show that 53.0% of the study population exhibited at least one medical condition during the twelve-month study period. As reported, this proportion varied substantially according to race, gender, and age. The study population also exhibited a number of interesting specific disease patterns, many of which also varied substantially according to the sociodemographic

Acknowledgements

This project was supported by Grant No. 98-CE-VX-0022 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Dept. of Justice. Points of view in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice. The authors are grateful to W. Michael Hollander for his assistance with data management of this project.

References (29)

B Anno
Prison Health CareGuidelines for the Management of an Adequate Delivery System
(1991)
B Anno
Health behavior in prisons and correctional facilities
J.E Paris
Inmate overutilization of health careIs there a way out?
J Correctional Health Care.
(1994)
S Sheps et al.
Prison health servicesA utilization study
J Comm Health.
(1987)
A Twaddle
Utilization of medical services by a captive populationAn analysis of sick call in a state prison
J Health Soc Behav.
(1976)
J Raba et al.
The health status of incarcerated urban malesResults of admission screening
J Prison Jail Health.
(1983)
I Weisfuse et al.
HIV-1 infection among New York City inmates
AIDS.
(1991)
J Glaser et al.
Correctional health careA public health opportunity
Ann Int Med.
(1993)
D Vlahov et al.
Prevalence of antibody to HIV-1 among entrants to US correctional facilities
JAMA.
(1991)
L Novick et al.
Health status of New York City prison population
Med Care.
(1977)

L Teplin

The prevalence of severe mental disorder among male urban jail detaineesComparison with the epidemiologic catchment area program

Am J Public Health.

(1990)

L Teplin

Psychiatric and substance abuse disorders among male urban jail detainees

Am J Public Health.

(1994)

R Braithwaite et al.

Prison and AIDSA Public Health Challenge

(1996)

D Gilliard

Prison and jail inmates at mid-year

(1998)

Cited by (144)

Sociodemographic, psychiatric and criminal characteristics of elderly offenders under evaluation for criminal responsibility in Turkey
2023, International Journal of Law and Psychiatry
The aim of this study was to examine a sample (n = 150) of elderly offenders to analyse the psychiatric, medical, demographic, criminal and if available neuropsychological test characteristics and criminal responsibility.
Data were gathered through a retrospective chart review of applicants aged 65 and over who were referred for determination of criminal responsibility from 2014 to 2019 at the Observation Department of Council of Forensic Medicine (Adli Tip Kurumu Baskanligi, Gözlem İhtisas Dairesi) who were evaluated under inpatient status by law.
There were 150 forensic cases aged 65 and over. The majority of the crimes were homicide (25.3%), homicide attempt (10%), and sexual offence (26%). The majority of sexual offence victims were children (34 of 39 cases). The percentages of decisions on criminal liability were as follows: 76% (n = 114) had full criminal liability, 21.3% of them (n = 32) had no criminal liability, 2.7% of them (n = 4) had reduced criminal liability. For the reduced/no criminal liability group, diagnoses were as follows: 37.1% dementia syndromes, 31.4% schizophrenia, 11.5% delusional disorder and 2.8% bipolar disorder manic episode.
When the findings in our study and current literature data are examined, it is seen that certain crime groups such as murder and attempted murder, and sexual crimes against children are high in elderly forensic psychiatric evaluations.
Management of acute subdural hematoma in incarcerated patients
2021, Clinical Neurology and Neurosurgery
Incarcerated patients have been documented to have higher rates of mental illness, substance abuse disorders, trauma, and chronic illnesses compared to non-incarcerated populations. In this study, we evaluated the incidence of subdural hematoma (SDH) in incarcerated patients and compared the outcomes of these patients to those of non-incarcerated patients.
We conducted a retrospective cohort study of incarcerated patients admitted to a hospital with acute SDH using the Nationwide Readmissions Database between 2016−2017. Nearest-neighbor propensity score matching for demographics was implemented to identify non-incarcerated control patients admitted with SDH. Analysis used chi-squared testing, Mann-Whitney U testing, and generalized binomial regression modeling.
A total of 962 incarcerated and non-incarcerated patients were identified at primary admission. No significant difference was found between the two cohorts with regards to rates of neurosurgical complications or readmissions. Incarcerated patients were found to receive a significantly lower number of procedures, including respiratory ventilation, intubation, central venous line placement, and imaging, during their primary admission (NPR = 2.7 ± 4.0) compared to non-incarcerated patients (NPR = 3.9 ± 4.9) (p = 0.00050), reduced length of stay (p = 0.0052), and reduced hospital costs (p = 0.00026) compared to non-incarcerated patients. Furthermore, female incarcerated patients with SDH had significantly worse outcomes compared to male patients with SDH, including higher rates of mortality (p = 0.0017) and 30-day readmission rates (p = 0.041).
Our study suggests that incarcerated patients may receive significantly fewer diagnostic and supportive procedures while admitted for SDH and may be discharged sooner than non-incarcerated patients with SDH. In addition, outcomes following SDH within incarcerated patients may be significantly worse for females.
The mental and physical health of older offenders: A systematic review and meta-analysis
2020, Neuroscience and Biobehavioral Reviews
A systematic review with meta-analysis was performed to: 1) estimate the prevalence of both mental and physical health problems in older offenders; 2) calculate relative risks for the health conditions in relation to non-offender older adults and; 3) explore the potential confounding role of several variables. We searched five databases up to August 2019. Studies involving offenders older than 50 years old were included. Fifty-five publications met criteria. The pooled prevalence for 18 mental and 28 physical health problems was calculated. In comparison with non-offender older adults, older offenders showed significantly higher risk for Hypertension (RR = 1.16, CI = 1.1, 1.2), Cardiovascular Diseases (RR = 1.24, CI = 1.09, 1.41), Respiratory diseases (RR = 1.75, CI = 1.29, 2.35), and Arthritis (RR = 1.19, CI = 1.12, 1.25). Heterogeneity was significant for all meta-analyses and partially explained by the confounding effect of country, the diagnosis assessment method, and the sample characteristics. Future research should include comparison groups of non-offender older adults and use longitudinal study designs to identify risk factors that can be targeted in preventive programmes.
Prevalence and correlates of diabetes among criminal justice–involved individuals in the United States
2019, Annals of Epidemiology
Citation Excerpt :
These complications could be exacerbated for probationers and parolees, who often experience limited access to health care on release from formal incarceration [4]. Most studies examining the rate of diabetes among this population find that the prevalence estimates are similar to the U.S. general population [5–8]; however, previous studies adjusting for age indicate that the prevalence is likely higher among inmates. For example, Wilper et al. [8] used data from the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze diabetes prevalence.
Diabetes is one of the most prevalent and fastest-growing adverse health conditions in the United States and disproportionately affects those demographic and socioeconomic groups that are also more likely to be involved with the criminal justice (CJ) system. This study examines the prevalence and correlates of diabetes among CJ-involved individuals in the United States.
Using traditional statistical modeling and modern machine learning methods, data from the National Study on Drug Use and Health were analyzed to compare the correlates and predictive interactions of diabetes diagnosis among those respondents on probation and parole to a sample, matched by age and gender, who were not.
Subjects involved in the CJ system were 15% more likely (1.66% vs. 1.44%, P = .015) to report a past-year diagnosis of diabetes than a sample of noninvolved individuals matched by age and sex, although this association was not statistically significant after adjusting for demographic and behavioral confounders. Similar trends in diabetes prevalence emerged for the non-CJ and CJ groups with regard to income, depression (OR of 2.38 and 1.65 for the CJ and non-CJ groups, respectively) and attainment of college education (OR of 0.64 and 0.30 for the CJ and non-CJ groups, respectively, compared with those with less than a high school education). Results also suggested that a generally high propensity toward risk taking had a negative effect on diabetes for the non-CJ group (OR 0.78; 95% CI 0.69–0.87), yet increased the odds of diabetes (OR 1.38; 95% CI 1.02–1.85) for the CJ group.
Involvement in the U.S. CJ system is correlated with a higher prevalence of diabetes and differing risk factors for diabetes diagnosis. Further research is necessary, however, to unpack the precise causal pathways that underlie the associational trends in the current analysis.
Exploring the potential association between gang membership and health outcomes in a longitudinal sample of youth and young adults
2020, Journal of Criminal Justice
Health criminology is an emerging line of inquiry that has focused on the association between crime/criminality and health outcomes. The current study sought to add to this literature by examining the potential connection between gang membership and health problems and brain-based disorders.
Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed.
The results revealed that gang membership was associated with only two (cancer and high blood pressure) of the potential 12 health problems and brain-based disorders. Additional analyses indicated that gang membership was related to a combined measure of health problems, but not to a combined measure of brain-based disorders or to a cumulative measure of health problems. Supplemental analysis also revealed that gang membership was associated with an increased odds of being shot or stabbed.
Gang membership does not appear to have sweeping negative effects on general health and brain-based disorders through young adulthood. We conclude by discussing the limitations of the study and directions for future research.
What are the characteristics of first time older sexual offenders?
2018, International Psychogeriatrics

View all citing articles on Scopus

View full text

Original reportsThe Disease Profile of Texas Prison Inmates

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Prison Health CareGuidelines for the Management of an Adequate Delivery System

Health behavior in prisons and correctional facilities

Inmate overutilization of health careIs there a way out?

J Correctional Health Care.

Prison health servicesA utilization study

J Comm Health.

Utilization of medical services by a captive populationAn analysis of sick call in a state prison

J Health Soc Behav.

The health status of incarcerated urban malesResults of admission screening

J Prison Jail Health.

HIV-1 infection among New York City inmates

AIDS.

Correctional health careA public health opportunity

Ann Int Med.

Prevalence of antibody to HIV-1 among entrants to US correctional facilities

JAMA.

Health status of New York City prison population

Med Care.

The prevalence of severe mental disorder among male urban jail detaineesComparison with the epidemiologic catchment area program

Am J Public Health.

Psychiatric and substance abuse disorders among male urban jail detainees

Am J Public Health.

Prison and AIDSA Public Health Challenge

Prison and jail inmates at mid-year

Original reports
The Disease Profile of Texas Prison Inmates