Cancer incidence among incarcerated and formerly incarcerated individuals: A statewide retrospective cohort study

Abstract

BackgroundCancer incidence among individuals with incarceration exposure has been rarely studied due to the absence of linked datasets. This study examined cancer incidence during incarceration and postincarceration compared to the general population using a statewide linked cohort.MethodsWe constructed a retrospective cohort from a linkage of state tumor registry and correctional system data for Connecticut residents from 2005 to 2016, and identified cancers diagnosed during and within 12 months postincarceration. We estimated incidence rates (including for screen‐detectable cancers) and calculated the standardized incidence ratios (SIR) for the incarcerated and recently released populations, relative to the general population. We also examined cancer incidence by race and ethnicity within each group.ResultsCancer incidence was lower in incarcerated individuals (SIR = 0.64, 95% CI 0.56–0.72), but higher in recently released individuals (SIR = 1.34, 95% CI 1.23–1.47) compared with the general population, and across all race and ethnic strata. Similarly, nonscreen‐detectable cancer incidence was lower in incarcerated and higher in recently released populations compared to the general population. However, non‐Hispanic Black individuals had elevated incidence of screen‐detectable cancers compared with non‐Hispanic White individuals across all three populations (incarcerated, SIR = 1.66, 95% CI 1.03–2.53; recently released, SIR = 1.83, 95% CI 1.32–2.47; and general population, SIR = 1.18, 95% CI 1.16–1.21).ConclusionCompared with the general population, incarcerated persons have a lower cancer incidence, whereas recently released persons have a higher cancer incidence. Irrespective of incarceration status, non‐Hispanic Black individuals have a higher incidence of screen‐detectable cancers compared with non‐Hispanic White individuals. Supplemental studies examining cancer screening and diagnoses during incarceration are needed to discern the reasons for observed disparities in incidence.

Incarceration History and Access to and Receipt of Health Care in the US

“…Cancer is a leading cause of disease-related death among justice system–involved people and will grow in importance as the justice system–involved populations are aging and cancer risk increases with age. Previous studies showed that incarceration was associated with higher cancer incidence, prevalence, and mortality rates . For example, a study using nationally representative data found that people with an incarceration history had higher age-adjusted prevalence of lung, cervical, and alcohol-related cancers compared with people without incarceration history .…”

“…Previous studies showed that incarceration was associated with higher cancer incidence, prevalence, and mortality rates. 38 , 39 , 40 For example, a study using nationally representative data found that people with an incarceration history had higher age-adjusted prevalence of lung, cervical, and alcohol-related cancers compared with people without incarceration history. 38 Using data from a few local jails or 1 state prison, earlier studies found that incarcerated people had lower rates of receiving colorectal or breast cancer screenings compared with the US average rates.…”

Identifying incarceration status in the electronic health record using large language models in emergency department settings

“…Previous research has been limited by the difficulty of correctly identifying this population. The use of NLP as a rapid and reliable mechanism to achieve this critical step opens the possibility of future research studies targeting issues such as the disproportionate mortality rate for those diagnosed with cancer during incarceration, or the elevated cardiovascular-related morbidity and mortality for those who have been exposed to the carceral system, and providing an opportunity to study quality of care delivery [ 28 , 29 ]. An effective means of identifying individuals that have had contact with the carceral system via the EHR can contribute to a more comprehensive understanding of a patient’s social determinants of health and improve access to real-time referrals to social programs aimed at enhancing healthcare outcomes and finding alternative means of rehabilitation.…”

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research

“…Moreover, in Connecticut, the incidence of cancer during incarceration exceeds that of the general population shortly after release from correctional facilities (standardized incidence ratio 1.34; 95% CI = 1.23–1.47). 37 This prompts an important question, like cancer, does incarceration correlate with increased incidence of surgical pathologies shortly after release? If so, are these occurring because of missed diagnosis or access to care in prison?…”