Abstract P234: Prison Inmate Awareness of Heart Disease Status While Incarcerated in State and Federal Prisons, 2016

Abstract

Background: Heart disease (HD) is the leading cause of death of inmates incarcerated in state prisons in the US, as it is in the general population. However, in 2001-2019 the mortality rate of HD in incarcerated populations was reported to increase, while it decreased in the US population. . This is despite constitutionally mandated access to healthcare. There are few studies assessing healthcare utilization in prison populations. The 2016 Survey of Prison Inmates is exceptional in that it explores utilization across both state and federal prisons, and allows us to explore factors that may contribute to decreased understanding of health status. Methods: This study is a secondary analysis of the 2016 Survey of Prison Inmates collected by the Bureau of Justice Statistics, a cross sectional survey of the state and federal prison population across the United States. Data collection took place from January to October 2016. All participants were above 18 years of age, incarcerated across 1808 state and 193 federal institutions. All analysis was restricted to those with a reported history HD, which included heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems. Awareness of their current heart disease status was operationalized by combining self-reported history and current heart disease status. Results: When asked, 27.9% of survey respondents reported a history of heart disease but denied currently having heart disease. Yet 89.3% of these unaware patients had seen a healthcare provider since incarceration. . Independent of age, those with difficulty walking/climbing stairs or doing activities alone, and older in age (all p<0.01) were more likely to be aware of HD status. Factors including veteran status (OR=0.7; CI: 0.5-0.9), homeless 30 days prior to incarceration (37.8% vs 27.7%; p=0.036) and those experiencing homelessness before 18 years of age (40.4% vs 25.8%; p<0.001) were associated with being unaware of heart disease status. Individuals with ADD/ADHD (prevalence=23.7%) had weaker (non-significant) association between awareness of their heart disease and healthcare utilizing behavior (Mantel-Haenszel test for heterogeneity; p=0.006). Meanwhile, those without ADD/ADHD had nearly 4 times the odds of correctly reporting their heart disease status if they had seen a provider (OR=3.90; CI: 2.32-6.59), compared to those who hadn’t seen one. Those with a history of ADD/ADHD were more likely to report experiencing homelessness prior to age 18 (p<<0.001), 30 days prior to arrest (p=0.002) and 12 months prior to arrest (p<0.001). Conclusions: Awareness was associated with utilizing healthcare since incarceration, but only 72.4% were clear that HD is a chronic condition. The associations between awareness and disability and other life experiences show an influence from socioeconomic status which could inform much-needed health promotion programming.