Chronic and Infectious Diseases in Justice-Involved Populations

The health profile of incarcerated populations, including the high rates of chronic and infectious diseases they experience, has been well-documented by correctional health researchers. Below you will find some key statistics about chronic and infectious diseases in incarcerated populations, but please see the additional references and resources below for a more comprehensive review, as well as the work of our Faculty.

• Hepatitis C is 9-10 times more prevalent in correctional facilities than in communities.

• In 2002, it was estimated that jails and prisons, respectively, had a 17 and 4 times greater prevalence of TB than the general population.

• The prevalence of diagnosed HIV in correctional facilities has declined, but remains 4-5 times higher among inmates than in the general population.

• Over half of prisoners with HIV are estimated to also have HCV.

• About 40% of all inmates are estimated to have at least one chronic health condition, such as asthma or diabetes.

• Nearly all chronic health conditions are more prevalent among inmates than in the general population.

• From 1990 to 2012, the U.S prison population aged 55 or older increased by 550 percent—older inmates, as in the general population, have higher rates of chronic health conditions, cognitive impairment or dementia, and disabilities

References and Resources

Cloud, D. (2014). On Life Support: Public Health in the Age of Mass Incarceration. Vera Institute of Justice.

Dumont, D., Brockmann, B., Dickman, S., Alexander, N. & Rich, Josiah. (2012). Public Health and the Epidemic of Incarceration. Annual Review of Public Health,33, 325-339.

Travis, J., Western, B., & Redburn, S. (Eds). (2014). The Growth of Incarceration in the United States: Exploring Causes and Consequences. National, Research Council. 202-232.

The items below are a list of recent, more in-depth articles that take the reader deeper into the subject area. The list is neither comprehensive nor exhaustive, but is intended to help a reader dive deeper into the subject matter at hand. We will be updating articles on a monthly basis.

Recall of Nadir CD4 Cell Count and Most Recent HIV Viral Load Among HIV-Infected, Socially Marginalized Adults

Buisker TR, Dufour MS, Myers JJ. AIDS Behav. 2015 Feb 26.
“Lower nadir CD4 cell counts and higher HIV viral loads are associated with increased risks of adverse events in the progression of HIV disease. In cases where medical records are inaccessible or incomplete, little evidence is available regarding whether nadir CDR cell count or HIV viral load is reliably reported in any patient population. We compare survey data collected from 207 HIV-infected individuals detained in San Francisco jails to data collected from electronic medical records (EMR) kept by the jails and community health providers. The sensitivity of self-reported nadir CD4 cell count less than 200 was 82 % [95 % confidence interval (CI) 68, 88], and the sensitivity of reporting an undetectable most recent HIV viral load was 93 % (95 % CI 84, 97). This suggests that in a highly socially marginalized population, nadir CD4 cell count and most recent HIV viral load are recalled accurately when compared to EMR.”

All-Cause, Drug-Related, and HIV-Related Mortality Risk by Trajectories of Jail Incarceration and Homelessness Among Adults in New York City
Lim S, Harris TG, Nash D, et al. Am J Epidemiol. 2015 Feb 15.
“We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period (all-cause SMR: 1.35, 95% confidence interval (CI): 1.14, 1.59; drug-related SMR: 4.60, 95% CI: 3.17, 6.46; HIV-related SMR: 1.54, 95% CI: 1.03, 2.21); all-cause and HIV-related SMRs in other patterns were not statistically significantly different. When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk.”