Abstract
BackgroundDespite the disproportionate incarceration of minorities in the United States, little data exist investigating how being incarcerated contributes to persistent racial/ethnic disparities in chronic conditions. We hypothesized that incarceration augments disparities in chronic disease.MethodsUsing data from the New York City Health and Nutrition Examination Study, a community-based survey of 1999 adults, we first estimated the association between having a history of incarceration and the prevalence of asthma, diabetes, hypertension using propensity score matching methods. Propensity scores predictive of incarceration were generated using participant demographics, socioeconomic status, smoking, excessive alcohol and illicit drug use, and intimate partner violence. Among those conditions associated with incarceration, we then performed mediation analysis to explore whether incarceration mediates racial/ethnic disparities within the disease.ResultsIndividuals with a history of incarceration were more likely to have asthma compared to those without (13% vs. 6%, p < 0.05) and not more likely to have diabetes or hypertension, after matching on propensity scores. Statistical mediation analysis revealed that increased rates of incarceration among Blacks partially contribute to the racial disparity in asthma prevalence.ConclusionHaving been incarcerated may augment racial disparities in asthma among NYC residents. Eliminating health disparities should include a better understanding of the role of incarceration and criminal justice policies in contributing to these disparities.
Highlights
Despite the disproportionate incarceration of minorities in the United States, little data exist investigating how being incarcerated contributes to persistent racial/ethnic disparities in chronic conditions
While African-Americans make up 13% of the general US population, they constitute 28% of all arrests and 40% of all people held in prisons and jails, whereas Whites make up 67% of the US population and 70% of all arrests, but only 40% of all people held in state prisons or local jails [3]
Using data from the NYC HANES, we examined the impact of having a history of incarceration on the prevalence of asthma, diabetes, and hypertension using both standard regression and propensity score matching techniques; empirically tested whether having a history of incarceration mediates racial and ethnic disparities in these conditions using statistical mediation analysis; and examined access to health care among those with prior incarceration
Summary
Despite the disproportionate incarceration of minorities in the United States, little data exist investigating how being incarcerated contributes to persistent racial/ethnic disparities in chronic conditions. While the specific reasons for increased rates of disease in this population are under investigation, researchers have identified a number of different pathways for why incarceration might augment chronic conditions. Prisons and jails are often poorly ventilated, dilapidated, and overcrowded--sites for transmission or exacerbation of respiratory diseases [8,9]. They offer limited opportunities for cardiovascular disease prevention through healthy diets, regular exercise, or chronic disease education and selfmanagement skills [10,11]. Individuals released from prison face legal barriers to employment, housing, public entitlements, and educational opportunities,[12,13,14] which may exacerbate already limited access to community health care and medical treatment
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