Increased risk of hospitalization following the release of inmates

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1. The odds of hospitalization following incarceration were highest in the seven days following release. 

2. The most common reason for hospitalization among former inmates were mental health disorders. 

Evidence Rating Level: 2 (Good)   

Study Rundown: Correctional health care systems are responsible for the health care of inmates while incarcerated; however upon release, inmates are confronted with variety of barriers to accessing the healthcare system. This study looked at the hospitalization rates among inmates at 7, 30, and 90 days after release. The principle outcomes measured included: hospitalization rates, mortality rates and primary diagnosis. There was a higher risk of hospitalization and mortality among the cohort recently released from prison compared to those not incarcerated. Furthermore, those that were incarcerated were more likely to be hospitalized for mental health disorders, injury, infections, and poisonings.

One limitation of this study was their inability to account for the pre-incarceration morbidity of the inmates. Given that this population of individuals has higher rates of substance abuse and mental health disorders it is plausible that this could have contributed to their increased hospitalization rates following release. Nonetheless, the major strengths of this study are the size of the cohort and the applicability to a number of different disabilities. Overall, the conclusion from this study implies that the transition from correctional facilities for inmates is one of increased morbidity and mortality and suggests the increased need for healthcare services for this population.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Release from prison- a high risk of death for former inmates

In-Depth [retrospective cohort study]: This study compared 144,323 Medicare fee-for-service beneficiaries released from US correctional institutions from January 1, 2002 to December 31, 2010 to 110,419 matched Medicare beneficiaries. The primary study outcomes were hospitalization rates at 7, 30 and 90 days after release from a correctional facility. The odds of hospitalization following release compared those never incarcerated were as follows:  Odds ratio (OR) 2.5 (2.3-2.8) after 7 days, OR 2.1 (2.0-2.2) after 30 days and 1.8 (1.7-1.9) after 90 days. The odds of mortality were also increased among those incarcerated: OR 2.1 (1.7-2.5) after 30 days and 2.0 (1.8-2.2) after 90 days. The most common reason for hospitalization among former inmates was mental health disorders accounting for 86% of those admitted (p <0.001). Inmates who were incarcerated for ≥ 1 year were less likely, when compared to those incarcerated for less than a year, to be admitted within 30 days following release (p <0.001).

By Camellia Banerjee and Brittany Hasty

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