Relationship Between Individual Incarceration History and Neighborhood Incarceration Rate on Asthma Outcomes in New York City: A Multilevel Approach

Background. Asthma morbidity and mortality and incarceration disproportionately affect minority individuals living in poor urban areas. We hypothesized that there would be a relationship between individual incarceration history and neighborhood incarceration rate on asthma and asthma-related severity outcomes.

Methods. We employed multilevel modeling techniques to examine the relationship between individual-level history of incarceration and neighborhood incarceration rate on self-reported history of asthma using data from the New York City Community Health Survey (2004), a community-based survey of 9585 randomly sampled city residents. Among asthmatics, we further explored the association between incarceration history and severity of asthma, measured by self-reported symptoms and asthma-related emergency room visits in the last year. We ran staged, multivariable models controlling successively for: 1) participant sociodemographic characteristics (age, gender, race, place of birth, and marital status), 2) modifiable behaviors (smoking and body mass index), 3) socioeconomic status (education and income), and 4) environmental exposure (rats and second-hand smoke). Finally, given the concentration of incarceration in Black and Hispanic populations, we looked for differential effects of neighborhood incarceration on asthma in these populations.

Results. Five percent (N=466) of the respondents reported an adult history of incarceration, and the mean rate of incarceration by neighborhood was 5.0% (range 1.4%-9.5%). Individuals with a history of incarceration had increased odds of asthma (OR 1.44, 1.20-1.68) compared to those without, and this association persisted after adjustment for sociodemographic characteristics, modifiable behaviors, socioeconomic status, and environmental factors (adjusted OR 1.45, 1.12-1.78). Higher neighborhood rate of incarceration was also associated with an increased of odds of asthma (OR 1.10, 1.14-1.60) in unadjusted models; however, this effect went away after adjustment for the remaining predictors in the overall model, and we found no independent effect in Black or Hispanic populations. Among asthmatics, there were no differences in asthma symptoms or asthma-related emergency department visits by history of incarceration.

Conclusions. Among adult New York City residents, asthma was more common among individuals with a history of incarceration, and this association persisted even after adjustment for sociodemographic characteristics, smoking, and environmental factors. While the mechanism of this association warrants further exploration, screening for and treating asthma during incarceration and upon release may be important in reducing asthma morbidity.