U.S. prison inmates may be severely undertreated for common chronic health conditions, such as asthma, type 2 diabetes, HIV and mental illness, new research suggests.

While researchers lacked complete inmate data, they reached this conclusion through a variety of sources, including national health survey data from 2018 to 2020 and a commercial prescription database.

They found that recently incarcerated individuals with type 2 diabetes accounted for about 0.44% of U.S. cases. Yet they received about 0.15% of oral anti-hyperglycemic medications. That’s a nearly threefold difference.

Jailed individuals with asthma made up 0.85% of the U.S. asthma population, the study found, but only 0.15% of asthma treatment volume, a more than fivefold difference.

“Our findings raise serious concerns about the access to and quality of pharmacologic care for very common chronic health conditions among the incarcerated,” said senior author Dr. G. Caleb Alexander, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“We knew going in that the U.S. incarcerated population has a higher prevalence of some chronic diseases,” he said in a school news release. “But we were really surprised by the extent of potential undertreatment that we identified.”

Past research has found evidence that the estimated 2 million people incarcerated in the United States receive poor quality health care under conditions that include too little funding and too few staff.

Researchers said few studies have examined treatment of common and chronic diseases such as diabetes and asthma.

“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, an associate professor of health policy and management at Johns Hopkins.

“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,” he noted in the release.

The researchers worked with two sets of estimates. One estimated the prevalence of specific conditions among recently incarcerated inmates. The other focused on the percentage of prescriptions for common chronic illness going to local jails and state prisons. Federal data were not available.

The authors adjusted for the possibility of missing data and noted that disparities between incarcerated individuals and others may be underestimated.

The analysis found a heavy burden of some illnesses behind bars.

For hepatitis, researchers estimated a 6.08% prevalence among the incarcerated versus 1.41% for the non-incarcerated. For HIV infection, researchers estimated 0.84% prevalence among inmates versus 0.28% in others.

For depression, estimated prevalence was 15% in inmates compared to 7.64% in others. Severe mental illness was 13.12% compared to 4.89% in others.

Incarcerated individuals with HIV represented about 2.2% of the U.S. total, but got only 0.73% of HIV antivirals, a threefold difference, researchers estimated.

Incarcerated individuals with severe mental illness represented an estimated 2% of U.S. cases. But they received about 0.48% of treatments, including antipsychotics and mood stabilizers, a fourfold gap, the study found.

Alexander said the findings may reflect not only institutional neglect but also factors such as the temporary nature of many local jail stays. They may also reflect a high prevalence of mental illness, which can complicate treatment of other conditions in the incarcerated population.

Study findings were published online April 14 in JAMA Health Forum.

More information

The U.S. Centers for Disease Control and Prevention has more on health care issues in inmates.

SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, April 14, 2023

Source: HealthDay