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Higher risk of hospitalization after prison release

Inmates use mirrors to watch other inmates participate in a full-body resistance workout competition at the main courtyard, from their cell
Inmates use mirrors to watch other inmates participate in a full-body resistance workout competition at the main courtyard, from their cell

By Andrew M. Seaman

NEW YORK (Reuters Health) - People who were recently released from prison are more likely to be admitted to a hospital than those who were never incarcerated, according to a new study.

Researchers found one in 70 former inmates is hospitalized within the first seven days of being released. At three months post-release, that grows to one in 12.

"Many individuals return home from a correctional facility and they're a vulnerable population - particularly vulnerable in terms of death and using the hospital," said Dr. Emily Wang, the study's lead author from the Yale University School of Medicine in New Haven, Connecticut.

Wang and her colleagues write in JAMA Internal Medicine that former inmates go from prison healthcare systems, where care is provided and access is guaranteed, to the general U.S. health system, which has more barriers to care, including primary care.

According to the U.S. Bureau of Justice Statistics, there were about 1.6 million prisoners in federal or state custody in 2011.

Previous research has found about 80 percent of former inmates have some sort of chronic medical condition. But only about 25 percent visit a doctor in the year following their release, write the researchers.

Other studies have found that recently released inmates have a high risk of death.

For the new study, Wang and her colleagues used data from Medicare - the U.S. government-run health insurance for the elderly and disabled - to compare hospital use between 110,419 former prisoners released between 2002 and 2010 and an equal number of similar people who were never in prison.

The former inmates were mostly men, white and received Medicare because they were disabled.

Overall, Wang found inmates were about twice as likely to be admitted to the hospital during the first seven, 30 and 90 days following their release.

They found 1.4 percent of former inmates were admitted to a hospital within seven days of release, compared to about 0.6 percent of Medicare recipients who had never been incarcerated and were hospitalized over a one-week period.

That grew to 3.9 percent of just-released inmates versus 1.9 percent of non-prisoners who were hospitalized over one month, and 8.3 percent of ex-prisoners versus 4.8 percent of other Medicare enrollees who were hospitalized over three months.

Inmates were more likely to be admitted to the hospital with a condition that could potentially be managed in doctors' offices, including diabetes, asthma and high blood pressure. They were also more likely to die before ever getting to a hospital.

"I think there are a number of explanations that could explain the higher rates. One is ... people who return from prison have more (chronic health problems). Another explanation is that they have an acute decline in their health after incarceration. Or, they just receive worse healthcare in the correctional facility," Wang said.

She added that her group is digging deeper into this topic to examine - among other things - the economic impact of these hospitalizations and possible health disparities between races.

Dr. Ingrid Binswanger, who has studied the health of recently released inmates but wasn't involved in the new study, said it's also important to find ways to possibly avoid these hospitalizations and deaths.

"Clearly we need some interventions to avoid preventable hospitalizations and deaths that occurred before people got to the hospital," Binswanger, from the University of Colorado School of Medicine in Aurora, told Reuters Health.

For example, she said there may be a need to help former inmates overcome a reluctance to call 911 for emergencies, which could be one reason that they're more likely to die outside of hospitals.

"The criminal justice system touches many people and many communities so I think this is an area that's important," she added.

SOURCE: http://bit.ly/12LXht4 JAMA Internal Medicine, online July 22, 2013.

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