Objective: The higher risk of death among recently released inmates relative to the general population may be because of the higher prevalence of substance dependence among inmates or an independent effect of incarceration. We explored the effects of recent incarceration on health outcomes that may be intermediate markers for mortality.
Methods: Longitudinal multivariable regression analyses were conducted on interview data (baseline, 3-, 6-, and 12-month follow-up) from alcohol- and/or drug-dependent individuals (n = 553) participating in a randomized clinical trial to test the effectiveness of chronic disease management for substance dependence in primary care. The main independent variable was recent incarceration (spending ≥1 night in jail or prison in the past 3 months). The 3 main outcomes of this study were any traumatic injury, substance use–related health consequences, and health care utilization—defined as hospitalization (excluding addiction treatment or detoxification) and/or emergency department visit.
Results: Recent incarceration was not significantly associated with traumatic injury (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.65-1.49) or health care utilization (AOR = 0.88; 95% CI: 0.64-1.20). However, recent incarceration was associated with higher odds for substance use–related health consequences (AOR = 1.42; 95% CI: 1.02-1.98).
Conclusions: Among people with alcohol and/or drug dependence, recent incarceration was significantly associated with substance use–related health consequences but not injury or health care utilization after adjustment for covariates. These findings suggest that substance use–related health consequences may be part of the explanation for the increased risk of death faced by former inmates.
From the Division of Preventive Medicine (NR), University of Alabama at Birmingham; Division of Hospital Medicine and Department of Quantitative Health Sciences (LSH), University of Massachusetts Medical School, Memorial Campus, Worcester, MA; Clinical Addiction Research and Education Unit (DMC, JHS, RS), Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; Department of Biostatistics (DMC), Data Coordinating Center (MRW), Department of Community Health Sciences (JHS), and Department of Epidemiology (RS), Boston University School of Public Health, Crosstown Center, Boston, MA; and School of Health Sciences (DAD), Cleveland State University, Cleveland, OH.
Send correspondence and reprint requests to Nicole Redmond, MD, PhD, MPH, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 610, Birmingham, AL 35294. E-mail: firstname.lastname@example.org.
Analyses were conducted while Drs Redmond and Hicks were affiliated with the Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts. Dr Redmond was supported by an Institutional National Research Service Award for Primary Medical Care funded by the Health Research Services Administration of the Department of Health and Human Services (T32HP10251-02), a National Institutes of Health Research Supplement to Promote Diversity in Health-Related Research (3R01DA010019-11S2) through the National Institute on Drug Abuse, and the Harvard Medical School Post-Graduate Fellowship in Health Disparities. Currently, Dr Redmond is supported by grants from the Centers for Medicaid and Medicare Services (1CMS331071-01-00 and 1C1CMS331300-01-00) and a National Institutes of Health Research Supplement to Promote Diversity in Health-Related Research (3R01HL080477-07S1) through the National Heart, Lung, and Blood Institute.
Dr Hicks was supported by the Health Disparities Program of Harvard Catalyst, The Harvard Clinical and Translational Science Center (1UL1RR025758-01 and financial contributions from participating institutions).
The Addiction Health Evaluation And Disease management Study (also known as the Enhanced Linkage of Drug Abusers to Primary Medical Care) was funded by grants from the National Institute of Drug Abuse (5R01DA010019), the National Institute of Alcoholism and Alcohol Abuse (5R01AA010870), and the National Center for Research Resources (UL1RR025771) and was based at Boston Medical Center.
The study's contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health, the National Institute on Drug Abuse, the National Institute of Alcoholism and Alcohol Abuse, the National Center for Research Resources, or the Department of Health and Human Services.
Dr Redmond conducted the literature search, designed the study, performed significant portions of the initial statistical analysis, and drafted and revised the manuscript. Dr Hicks assisted with the study design and manuscript preparation. Dr Cheng provided biostatistical expertise for the analytic methods. Dr Allensworth-Davies and Mr Winter undertook the final statistical analyses. Drs Saitz and Samet are the principal investigators of the parent study and provided access to the data. All authors significantly contributed to the study design and interpretation of the data, and contributed to and approved the final manuscript.
Dr Hicks is on the National Advisory Council of the Society of General Internal Medicine and National Advisory Committee to the National Library of Medicine. The authors have no other disclosures or conflicts of interest to report.
Received April 12, 2013
Accepted October 26, 2013