Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
BMC Public Health. 2024 Oct 8;24(1):2746. doi: 10.1186/s12889-024-20196-3.
Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults.
Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015-2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates.
For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06-1.31) but not older adults (IRR 0.99, 95% CI 0.85-1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08-1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57).
Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization.
大规模监禁时代已经过去了五十年，越来越多的老年人在一生中都经历过刑事法律介入（CLI）。研究表明，先前的监禁与大量疾病负担有关，但对于一生中经历过 CLI 的中年和老年人与没有经历过 CLI 的同龄人相比，他们的独特需求和利用模式知之甚少。本研究使用全国代表性数据集，检验了一生中 CLI 暴露与中年和老年人急性护理服务使用之间的关联。
我们的样本包括 44007 名美国成年人（25074 名中年-50-64 岁；18709 名老年-≥65 岁），他们参加了国家药物使用和健康调查（2015-2019 年）。数据是公开的。我们的自变量是一生中 CLI。我们使用中年和老年人的单独负二项回归模型，在控制相关社会人口学协变量的情况下，检验了一生中 CLI 与急性医疗保健利用（ED 就诊和住院夜数）之间的关联。
对于中年受访者，19.1%报告了一生中 CLI；对于老年受访者，暴露率为 9.6%。在多变量模型中，CLI 与中年成年人 ED 就诊次数增加相关（IRR 1.18，95%CI 1.06-1.31），但与老年成年人无关（IRR 0.99，95%CI 0.85-1.16）。CLI 与两组住院夜数增加相关（中年：IRR 1.33，95%CI 1.08-1.62；老年：IRR 1.26，95%CI 1.01-1.57）。
一生中经历过 CLI 的中年和老年人比没有一生中 CLI 的同龄人更频繁地使用急性护理服务，即使在调整了混杂因素之后也是如此。随着大规模监禁时代的成年人年龄的增长，了解一生中 CLI 如何影响健康结果的机制对于设计干预措施以改善结果和减少不必要的急性医疗保健利用至关重要。
