The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada

Abstract

BackgroundMany people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population.MethodsWe conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population.ResultsThe rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons.ConclusionsAcross care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.

“When you first walk out the gates…where do [you] go?”: Barriers and opportunities to achieving continuity of health care at the time of release from a provincial jail in Ontario

“…Provincial correctional facilities hold people who are admitted to custody without sentencing and people sentenced to less than two years in custody [43]. Recent data indicate that the median length of stay for people in provincial correctional facilities in Ontario is 10 days with an interquartile range of 3 days to 52 days [13]. For Ontario residents, hospitalizations and medically necessary physician services including primary care and emergency department visits are paid for through the public health insurance system, the Ontario Health Insurance Plan, including while in provincial correctional facilities.…”

“…Improving health in people who experience incarceration is therefore an important pathway to improving public health and health equity in Canada [2]. The period after release from custody is particularly challenging to health, as indicated by increased risks of morbidity and mortality [13][14][15][16]. People face urgent issues on release from jail and prison, including finding housing and employment, reconnecting with family, and meeting conditions of release [17][18][19][20][21][22][23], which may compete with addressing health and health care needs [24].…”

Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study

“…We accessed data from the Ontario Ministry of Community Safety and Correctional Services on all adults who were released from provincial prison in 2010. As described elsewhere [13], these data were linked using unique encoded identifiers with health administrative data at ICES, an independent, non-profit organization funded by the Ontario Ministry of Health and Long-Term Care, which houses health administrative data for Ontario residents.…”

“…In exploratory analyses as part of a larger project on health care utilization of people released from provincial prison in 2010 [13], we identified 466 medical-surgical hospitalizations in women and 1,722 in men from 2005 to 2015 in prison or in the 6 months after release. Due to repeat hospitalizations and hospitalizations for pregnancy-related causes, we expected there would be fewer total people with medical-surgical hospitalizations not related to pregnancy.…”

“…People who experience imprisonment face a greater burden of illness on average compared to the rest of the general population, with a higher prevalence of infectious diseases, chronic diseases, and mental health and substance use disorders [8]. The period after release from prison is associated with particularly high morbidity and mortality, with several studies showing increased rates of medical-surgical hospitalization compared to the general population [9][10][11][12][13][14][15][16][17][18]. Health care access and quality may be suboptimal for this population while in prison and after prison release [13,19], with substantial impacts on individual and population health [20].…”