Disparities in cancer incidence and mortality for individuals incarcerated in Massachusetts (MA) state prisons compared to the general population.

Abstract

187 Background: More than 10 million people are incarcerated annually in the US. Incarcerated individuals are disproportionately affected by cancer disparities, yet receive healthcare while in prison which may offer opportunities for enhanced cancer screening and treatment. Little research has evaluated disparities in cancer incidence and survival among incarcerated patients. Methods: Name, birth date, and sex were obtained for individuals incarcerated in MA state prisons from 2010-2019 from the MA Department of Corrections and matched to MA state cancer registry data. Patients diagnosed with an incident cancer were classified as currently incarcerated (CI), formerly incarcerated (FI), or never incarcerated (NI) based upon incarceration status at diagnosis. We examined crude cancer incidence, standardized incidence ratios (SIR) and crude overall survival (OS) by incarceration status, and evaluated survival differences with Cox proportional hazards models adjusted for age, sex, race, ethnicity, diagnosis year and cancer type. Results: Of 416,267 cancers diagnosed in 2010-2019, 288 (0.1%) CI, 785 (0.2%) FI and 415,194 (99.7%) NI patients were diagnosed with cancer. Demographics differed by incarceration status (median age: 57 vs 54 vs 66 years for CI, FI and NI, respectively; males: 92.4% vs 71.6% vs 46.4%; and Whites: 69.8% vs 77.3% vs 89.4%; all P≤0.01). The most common cancers detected are in Table. Detection of screenable cancers were highest in CI and NI patients (51.4% and 51.0%) and lowest in FI patients (46.2%; p=0.03). However, of those diagnoses, 25.6% of CI and 22.6% of FI were diagnosed with Stage IV disease, compared with 16.4% of NI patients (p=<0.0001). Crude incidence per 100,000 patient years was 271.7 for CI, 267.9 for FI and 773.2 for NI patients. Compared to NI men, the SIR was 97.6 (95% CI 86.2-110.1) for CI men and 109.5 (95% CI 100.6-118.9) for FI men. Unadjusted 1-year all-cause OS was 68.1% for CI, 72.6% for FI and 76.5% for NI patients, while 5-year OS was 36.4% for CI, 53.2% for FI and 60.9% for NI patients (Table). In adjusted models, CI and FI patients had statistically worse OS, compared with NI (CI vs. NI: HR 2.17, 95% CI 1.84-2.56; FI vs. NI: HR 1.85, 95% CI 1.66-2.07). Conclusions: In MA, CI and NI patients are more likely than FI patients to have screenable cancers detected. However, CI and FI patients are more likely to be diagnosed with stage IV disease, and have worse all-cause OS, compared to NI patients. Research on cancer screening and treatment in prisons is needed to improve cancer outcomes for CI and FI patients.[Table: see text]