Study: Patients with history of incarceration less likely to receive preventive care

Key takeaways:

• Incarceration history lowered the chances of having a usual source of care.
• The researchers suggested multiple solutions, like linking correctional facilities and community health systems.

Patients with an incarceration history were less likely to receive preventive care, such as physical examinations, BP tests or cancer screenings, according to a study in JAMA Network Open.

“The physical, psychological, and socioeconomic consequences of being incarcerated may exacerbate inequities in access to health care,” Jingxuan Zhao, MPH, a senior associate scientist at the American Cancer Society, and colleagues wrote. “Compared with individuals without any history of incarceration, people with incarceration history are less likely to have health insurance coverage, which is a strong determinant of access to care.”

In the study, the researchers analyzed data from a 10-year period — from 2008 to 2018 — pertaining to 7,963 adults enrolled in the National Longitudinal Survey of Youth. In that cohort, 586 individuals had been incarcerated.

Zhao and colleagues found that, compared with patients with no incarceration history, patients with an incarceration history had lower percentages of having a usual source of care or receiving preventive services, which included:

• BP tests (85.6% vs. 91.6%);
• physical examinations (69.6% vs. 74.1%);
• blood cholesterol level tests (59.5% vs. 72.2%);
• dental checkups (51.1% vs. 66%);
• blood glucose level tests (61.4% vs. 69.4%);
• breast cancer screenings (55% vs. 68.2%); and
• colorectal cancer screenings (65.6% vs. 70.3%).

After the researchers adjusted for demographic factors, education and health insurance coverage, most associations between incarceration and access to care were attenuated, except for having a usual source of care, routine dental checkups and blood tests for cholesterol levels, which remained statistically significant.

The findings suggest that improving health insurance coverage and access to education — particularly among diverse groups — “is important for reducing disparities in health outcomes,” according to Zhao and colleagues.

“Expanding programs to provide access to education and training in correctional facilities and educational supports after release will be needed,” they wrote.

The researchers also suggested linking correctional facilities and community health systems to “facilitate access to resources and a smooth reintegration.”

“Providing training to health professionals in correctional facilities and the community could also be associated with improved cultural competence and the ability of health care professionals to demonstrate trustworthiness when caring for justice system-involved people,” they wrote.