Self-reported prevalence of medical conditions within a correctional population.

The prevalence of a wide variety of chronic medical conditions within the 2 million-strong U.S. prison population is very high. Approximately 25 percent to 40 percent of all inmates at release have chronic medical conditions requiring continued health care services (McVey, 2001). Considering that approximately 600,000 inmates are paroled each year, the need for continued care is staggering (Bureau of Justice Statistics, n.d.: The Sentencing Project, n.d.; Strickland, 2002; Craig and York, 2003). When the chronic health care needs of parolees are addressed, they seem to be more likely to comply with the requirements of their parole. Conklin (2004) reported a 36.5 percent re-incarceration rate when health care needs are addressed as compared with a national average of 51.8 percent. This suggests that a rational approach to the management of common chronic health care problems may reduce recidivism rates in this population.

Background

Multiple factors are influencing the health care needs of the current population of incarcerated offenders. Some of these factors are a growing female population, a population that is getting older, increased rates of common conditions significantly higher than the rates of the general population and the influence of psychosocial issues on overall health.

Women in corrections. In 1998, an estimated 950,000 women were under the control of correctional agencies (Strickland, 2002). Since 1998, that number has grown tremendously; many are now incarcerated due to methamphetamine-related convictions. Up to 60 percent of these women are victims of domestic violence (Strickland, 2002). Females typically use health care services more frequently than males in the general population. Incarcerated females are no different, and with the increased rate of chronic medical conditions in this population, female inmates are at a particularly high risk for under-diagnosis and under-treatment of significant chronic medical conditions (Strickland, 2002). The unique health care needs of females will become more of a burden to the correctional system as the population of female inmates continues to grow (Bureau of Justice Statistics, n.d.; Strickland, 2002; National Center for Health Statistics, n.d.).

Aging population. The current correctional population is rapidly aging, which puts this portion of the prison population at increased risk for chronic illnesses such as diabetes, hypertension and coronary artery disease. Additionally, elderly men and women require screening for colon cancer, prostate cancer, breast cancer and many other conditions that become more prevalent as people age. Left untreated, these inmates will be less likely to provide for themselves upon release and will become more of a health care burden to society.

Diabetes. Hornung, Greifinger and Gadre (2005) estimate that using current diabetes diagnosis guidelines there are 43,500 cases of Type II diabetes in the prison population. If the newer proposed diabetes diagnosis guidelines are used then approximately 30,000 more cases of diabetes are present. If those inmates with suspected abnormal glucose metabolism (impaired fasting glucose) are also included, the estimated number of cases of diabetes is more than 150,000 (Hornung et al. 2005).

Hypertension. Although there have been great advances in the earlier diagnosis and treatment of hypertension, it still remains one of the leading causes of heart disease, stroke and renal failure (Hornung et al. 2005). Hypertension is a disease found more frequently in males, with a higher percentage found in black males (Harrison and Beck, 2006). It is expected that there are upwards of 240,000 incarcerated males with hypertension (Hornung et al. 2005). Within this number, 89,428 (37 percent) are white, 120,003 (50 percent) are black and 29,825 (12 percent) are Hispanic.