Department of Family Medicine, McMaster University, Hamilton, Canada.
St. Michael's Hospital, Toronto, Canada.
PLoS One. 2018 Aug 3;13(8):e0201592. doi: 10.1371/journal.pone.0201592. eCollection 2018.
Many 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.
We 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.
The 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.
Across 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.
许多人每年都会入狱，而这些人在发病率和死亡率方面承受着不成比例的负担。各州有义务在监狱中提供公平的医疗保健，并在获释后照顾他们的医疗保健。我们的目的是描述 2010 年在安大略省从省级监狱获释的人的监狱内和出狱后的医疗保健使用情况，并将其与一般人群进行比较。
我们进行了一项基于人群的回顾性队列研究。我们纳入了 2010 年从省级监狱释放到社区的所有人，并与年龄和性别匹配的一般人群对照。我们将从监狱获释人员的身份与行政医疗数据相关联。我们按年龄和性别与每个获释人员匹配了四个一般人群对照。我们检查了监狱内和出狱后三个月内的门诊护理和急诊部门的使用情况，以及医疗手术和精神病住院情况。我们将这些数据与一般人群的数据进行了比较。
与一般人群相比，从监狱获释的人（n=48861）在监狱内和出狱后的所有类型的医疗保健使用率均显著更高（n=195444）。与从监狱获释的人相比，与一般人群在监狱和出狱后 3 个月内的使用率分别为：门诊护理分别为 5.3（95%CI 5.2,5.4）和 2.4（95%CI 2.4,2.5），急诊部门利用率分别为 3.5（95%CI 3.3,3.7）和 5.0（95%CI 4.9,5.3），医疗手术住院率分别为 2.3（95%CI 2.0,2.7）和 3.2（95%CI 2.9,3.5），精神病住院率分别为 21.5（95%CI 16.7,27.7）和 17.5（14.4,21.2）。与监狱内的时间相比，出狱后第一周的门诊护理使用率从 16.0（95%CI 15.9,16.1）降至 10.7（95%CI 10.5,10.9）就诊/人年，急诊部门使用率从 0.7（95%CI 0.6,0.7）增加到 2.6（95%CI 2.5,2.7）就诊/人年，住院率从医疗原因的 5.4（95%CI 4.8,5.9）增加到 12.3（95%CI 10.1,14.6）人/100 人年，医疗手术原因的 8.6（95%CI 7.9,9.3）增加到 17.3（95%CI 14.6,20.0）人/100 人年精神病原因。
在安大略省，监狱内和出狱后的各种医疗保健使用率对经历监禁的人来说都很高。这可能反映了发病率高和获得高质量医疗保健的机会不佳。未来的研究应确定增加使用的原因，并采取干预措施以改善医疗服务。
