Past Incarceration a Key SDOH Causing Chronic Disease in Older Adults

Older patients with a history of incarceration are more likely to develop a chronic disease than those without prior incarceration, according to new research out of the University of California San Francisco (UCSF) underscoring incarceration as a social determinant of health (SDOH).

The incarcerated population has grown dramatically in the last 40 years, with nearly 2 million people in a United States prison or jail. That is a 400 percent increase between 1980 and 2020.

“The proportion of incarcerated older adults also rose precipitously,” lead study author Ilana R. Garcia-Grossman, MD, current VA fellow in the UCSF National Clinician Scholars, wrote in the study. “However, little is known about the health impacts of incarceration in later life or even the precise number of people in the US who have experienced incarceration during their lifetime.” 

“This is in part due to the fragmentation of data among the county, state, and federal correctional institutions and the limited number of national population-based surveys that ask participants about their history of incarceration,” Grossman and colleagues continued.

Researchers sought to understand the association between incarceration and health among community-dwelling older adults for future clinical and policy implications.

The study, published in JAMA Network Open, examined Health and Retirement Study data from over 13,000 community-dwelling adults aged 50 years or older between 2012 and 2014.

In the representative sample of older US adults, researchers found that at least 1 in 15 adults experienced incarceration during their lifetime. However, the researchers stated that this number might be underestimated as the Health and Retirement Study data does not account for patients without a phone, those who are unhoused, or those who are incarcerated during the study period.

Under these statistics, a patient’s likelihood of incarceration is greater than their lifetime risk of developing colorectal cancer.

Grossman and her team also found that a history of incarceration was strongly linked with the development of chronic disease, increasing the risk by 20 to 80 percent.

“Additionally, exposure to incarceration may exacerbate poor health outcomes through exposure to trauma and violence, acute and chronic stress from living in dehumanizing conditions, and variable access to healthy food, physical activity, and high-quality healthcare,” Grossman and colleagues stated. “It is also possible that incarceration leads to downstream barriers to other social determinants of health, such as employment or housing, which in turn contribute to poor health.”

“Overall, this study suggests that having a history of incarceration is an important factor associated with poor health in older age,” the researchers affirmed.

The study findings are valuable for potential health policy changes for older adults recently released from jail or prison and for older patients with an incarceration history.

The teams also pointed to a lack of patient engagement for individuals with a history of incarceration, highlighting the need for SDOH to include incarceration screening.

Grossman said this is an area for future research.

“Such knowledge could inform the need for healthcare professionals to screen patients for a history of incarceration and could support the development of interventions to minimize the long-term effects of incarceration after release,” the researchers stated.

This study adds to the growing body of work that recognizes incarceration as an SDOH, yielding health disparities.

Research from July 2022 showed that past incarceration is indeed tied to health disparities and care access barriers, with significant decreases to specialty and primary care access for patients in the California prison system.

When looking at primary care, the researchers found that both referral and access to routine primary care went down drastically during the first two waves of the pandemic.

“Strategies, such as ‘front–end’ programs (e.g., drug treatment courts), providing comprehensive health care services during incarceration and linking people to health care services post release may help to improve the health and well–being of those who are incarcerated and those with a history of incarceration,” Healthy People 2020 recommends.