School of Population Health, University of New South Wales, 2052, Sydney, NSW, Australia.
The Wellbeing Group, 2040, Sydney, NSW, Australia.
BMC Public Health. 2022 Jan 10;22(1):64. doi: 10.1186/s12889-021-12460-7.
Prisoner health surveys primarily rely on self-report data. However, it is unclear whether prisoners are reliable health survey respondents. This paper aimed to determine the level of agreement between self-report and biomedical tests for a number of chronic health conditions.
This study was a secondary analysis of existing data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey. The health surveys were cross-sectional in nature and included a stratified random sample of men (n=2,114) from all NSW prisons. Self-reported histories of hepatitis, sexually transmissible infections, and diabetes were compared to objective biomedical measures of these conditions.
Overall, the sensitivity (i.e., the respondents who self-reported having the condition also had markers indicative of the condition using biomedical tests) was high for hepatitis C (96%) and hepatitis B (83%), but low for all other assessed conditions (ranging from 9.1% for syphilis using RPR to 64% for diabetes). However, Kappa scores indicated substantial agreement only for hepatitis C. That is, there were false positives and false negatives which occurred outside of chance leading to poor agreement for all other assessed conditions.
Prisoners may have been exposed to serious health conditions while failing to report a history of infection. It may be possible that prisoners do not get tested given the asymptomatic presentation of some conditions, were unaware of their health status, have limited health-service usage preventing the opportunity for detection, or are subject to forgetting or misunderstanding prior test results. These findings demonstrate the importance of the custodial environment in screening for health conditions and referral for treatment should this be needed. Testing on entry, periodically during incarceration, and prior to release is recommended.
囚犯健康调查主要依赖于自我报告数据。然而，目前尚不清楚囚犯是否是可靠的健康调查对象。本文旨在确定自我报告和生物医学测试在多种慢性健康状况方面的一致性程度。
本研究是对新南威尔士州（NSW）囚犯健康调查三个时间点（1996 年、2001 年和 2009 年）的现有数据的二次分析。健康调查本质上是横断面的，包括来自 NSW 所有监狱的分层随机男性样本（n=2114）。自我报告的肝炎、性传播感染和糖尿病病史与这些疾病的客观生物医学测量结果进行了比较。
总体而言，丙型肝炎（96%）和乙型肝炎（83%）的敏感性（即自我报告患有该疾病的受访者也通过生物医学测试有该疾病的标志物）较高，但其他所有评估疾病的敏感性较低（从使用 RPR 的梅毒的 9.1%到糖尿病的 64%不等）。然而，Kappa 评分仅表明丙型肝炎具有显著一致性。也就是说，存在假阳性和假阴性，这些结果超出了偶然发生的范围，导致所有其他评估疾病的一致性较差。
囚犯可能已经接触到严重的健康状况，但没有报告感染史。由于某些疾病无症状出现，囚犯可能没有接受过检测，或者不知道自己的健康状况，有限的卫生服务使用阻止了检测机会，或者由于遗忘或误解先前的测试结果而受到影响。这些发现表明，在需要时，监禁环境在筛选健康状况和转介治疗方面非常重要。建议在进入监狱时、监禁期间定期和释放前进行检测。
