Is Incarceration a Contributor to Health Disparities? Access to Care for Formerly Incarcerated Adults

Purpose: To examine whether a lifetime history of incarceration is associated with current health status and recent access to medical and dental care.

Background: Incarceration affects one's employability and eligibility for public services, but its impact on health status and access to healthcare is less known. Despite the disproportionate prevalence of incarceration in communities of color, few studies have examined its contribution to health disparities.

Methods: We performed a secondary data analysis of the 2007 Los Angeles County Health Survey, a population-based random-digit-dialing telephone survey of county households. Any history of incarceration in a prison/jail/detention center as an adult was assessed for a random subsample (n=985). Bivariable and multivariable logistic regression analyses examined whether incarceration history was associated with health status and access to care, controlling for other characteristics.

Results: Ten percent (n=102) had a lifetime history of incarceration. Incarceration was not associated with overall health status, number of chronic diseases, or mental or physical health in the past 30 days but was associated with a higher prevalence of current smoking (38% vs. 10%) and binge drinking (37 vs. 12%). Incarceration was not associated with being currently insured (85%), however the formerly incarcerated were 3 times more likely to have a period of being uninsured during the previous 12 months (18% vs. 6%) and were less likely to report a “regular source of care” (74% vs. 85%). The formerly incarcerated were less likely to have seen a doctor for a routine check-up (49% vs. 36%) or a dentist (50% vs. 33%) in the past year, or in the past 5 years (15% vs. 6% and 19% vs. 10%, respectively). The formerly incarcerated were more likely to report being unable to obtain needed medical (18% vs. 8%) or dental (36% vs. 16%) care within the past year because of an inability to afford it. In multivariable analyses, the formerly incarcerated were less likely to report a regular source of care (OR=0.5, 95% CI 0.3, 0.8), and more likely to report being “unable to afford to see a doctor” (OR=3.0, 95% CI 1.6, 6.3) and “unable to afford to see a dentist” (OR=3.75, 95% CI 2.3, 6.4) for a problem within the past year.

Conclusion: Incarceration history is independently associated with disparities in access to care. Interventions to improve access to care and the health of communities affected by high rates of incarceration could include efforts to target this population.