Rates of Chronic Conditions, Asthma in Prisons May Be Severely Undertreated, Study Finds

Incarcerated people are significantly less likely to be treated for chronic conditions, such as asthma, in which rates may be severely undertreated among the jail and prison population in the United States, according to one study.

“Our findings raise serious concerns about the access to and quality of pharmacologic care for very common chronic health conditions among the incarcerated,” said the study’s senior author G Caleb Alexander, MD, professor in the Department of Epidemiology at the Bloomberg School, in a statement.¹ “We knew going in that the US incarcerated population has a higher prevalence of some chronic diseases. But we were really surprised by the extent of potential undertreatment that we identified.”

The results of this cross-sectional descriptive study were published in JAMA Health Forum.2

The aim of this study was to evaluate the prevalence of prescription medications in jails and state prisons for individuals with chronic conditions, such as asthma, type 2 diabetes, hypertension, hepatitis B and C, HIV infection, depression, and severe mental illness compared with the non-incarcerated population.

The researchers used national health survey data from 2018 to 2020 to estimate the prevalence of chronic conditions among recently incarcerated individuals, and a commercial prescription database used to estimate the distribution of medication among the jail and prison population.

As a result, the researchers estimated the proportion of medications being sent to incarcerated jails and prisons was much lower compared to the burden of disease among this population:

• Incarcerated individuals with asthma account for 0.85% (95% CI, 0.67%-1.06%) of the asthma population, but only receive 0.15% asthma treatment volume
• Incarcerated individuals with diabetes account for 0.44% (95% CI, 0.34%-0.56%) of the diabetes population, but only 0.15% receive oral antihyperglycemic medications

Additionally, the researchers found that the incarceration populations accounted for chronic conditions:

1. Hypertension (0.42%; 95% CI, 0.35%-0.51%),
2. Hepatitis B or C (3.13%; 95% CI, 2.53%-3.84%),
3. HIV (2.20%; 95% CI, 1.51%-3.19%),
4. Depression (1.46%, 95% CI, 1.33%-1.59%), and
5. Severe mental illness (1.97%, 95% CI, 1.81%-2.14%).

After adjusting for disease prevalence, the researchers found the burden of the disease was 5.5-fold for asthma, 2.9-fold for diabetes, 2.4-fold for hypertension, 2.9-fold for hepatitis B or C, 3.0-fold for HIV, 4.1-fold for depression, and 4.1-fold for severe mental illness among the incarcerated population compared with the non-incarcerated population.

The researchers attribute these findings to several problems within the US jail and prison system, including understaffing, underfunding, and poor-quality health care. Furthermore, lack of transparency from prison health care providers creates difficulty for furthering research.

“Health care provided in jails and prisons is provided by a patchwork of health care providers, most commonly private contractors who do not widely share information about the services they provide to incarcerated people,” said study co-author Brendan Saloner, PhD, an associate professor in the Bloomberg School’s Department of Health Policy and Management, in a statemen. “The lack of transparency means that advocates and policymakers have a very incomplete picture of the medicines that are available during a stay in jail or prison.”

Despite limitations, the researchers believe the results of the study show enough evidence to suggest that there is a gap in prescribing pharmacological treatments to individuals with chronic conditions who have been incarcerated. Furthermore, evidence of undertreatment needs to continue to be investigated as a serious public health concern.

References

1. JohnsHopkinsSPH. Analysis of health and prescription data suggests chronic health conditions in U.S. incarcerated people may be severely undertreated. EurekAlert! https://www.eurekalert.org/news-releases/985864. Published April 14, 2023. Accessed April 24, 2023.

2. Curran J, Saloner B, Winkelman TNA, Alexander GC. Estimated use of prescription medications among individuals incarcerated in jails and state prisons in the US. JAMA Health Forum. 2023;4(4). doi:10.1001/jamahealthforum.2023.0482