Leading medical causes of mortality among male prisoners in Texas, 1992--2003.

Data from the Texas prison system and the Texas Vital Statistics Bureau were used to identify and assess the leading medical causes of death from 1992 to 2003 among male prisoners in Texas (N = 4,026). The leading medical causes of death were infection, cancer, cardiovascular disease (CVD), liver disease, and respiratory disease. Of these, only cancer showed a significant average annual increase in crude death rates (2.5% [0.2% to 4.9%]). Among prisoners aged 55 to 84 years, crude average annual death rates due to cancer and CVD were high and substantially exceeded death rates due to other causes. Among prisoners aged 25 to 44 years, crude average annual death rates due to infection exceeded death rates due to other causes. Continued improvements in the prevention, screening, and treatment of these conditions are warranted in correctional health care settings.

Prevalence of chronic medical conditions among inmates in the Texas prison system.

Given the rapid growth and aging of the US prison population in recent years, the disease profile and health care needs of inmates portend to have far-reaching public health implications. Although numerous studies have examined infectious disease prevalence and treatment in incarcerated populations, little is known about the prevalence of non-infectious chronic medical conditions in US prison populations. The purpose of this study was to estimate the prevalence of selected non-infectious chronic medical conditions among inmates in the Texas prison system. The study population consisted of the total census of inmates who were incarcerated in the Texas Department of Criminal Justice for any duration from September 1, 2006 through August 31, 2007 (N=234,031). Information on medical diagnoses was obtained from a system-wide electronic medical record system. Overall crude prevalence estimates for the selected conditions were as follows: hypertension, 18.8%; asthma, 5.4%; diabetes, 4.2%; ischemic heart disease, 1.7%; chronic obstructive pulmonary disease, 0.96%; and cerebrovascular disease, 0.23%. Nearly one quarter (24.5%) of the study population had at least one of the selected conditions. Except for asthma, crude prevalence estimates of the selected conditions increased monotonically with age. Nearly two thirds (64.6%) of inmates who were >or=55 years of age had at least one of the selected conditions. Except for diabetes, crude prevalence estimates for the selected conditions were lower among Hispanic inmates than among non-Hispanic White inmates and African American inmates. Although age-standardized prevalence estimates for the selected conditions did not appear to exceed age-standardized estimates from the US general population, a large number of inmates were affected by one or more of these conditions. As the prison population continues to grow and to age, the burden of these conditions on correctional and community health care systems can be expected to increase.

Sources of heterogeneity in hepatitis B virus (HBV) seroprevalence estimates from U.S. adult incarcerated populations: A systematic review and meta-regression analysis.

HBV seroprevalence estimates from U.S. incarcerated populations are relatively high. However, the usefulness of these estimates for guiding HBV-related correctional healthcare policy is limited by wide variation in estimates across studies and little understanding of the sources of this variation. The authors systematically reviewed studies indexed from 1975-2005, meeting pre-specified criteria and reporting HBV seroprevalence estimates from U.S. adult incarcerated populations. Using meta-regression techniques, the authors investigated report type, geographical region, serum collection year, facility type, serum source, sampling procedures, sample characteristics, and measurement procedures as potential study-level sources of heterogeneity in prevalence estimates for common HBV seromarkers. In bivariable meta-regression analyses, mean age ≥31 years was strongly associated with increased HBsAg prevalence (POR=2.6), and serum collection year before 1991 was strongly associated with increased prevalence of any positive marker (POR=2.0). Other moderate-to-strong associations were observed, but these were considered less certain because of small numbers of observations, influence of single studies, or potential confounding. Potential sources of heterogeneity should be considered when comparing HBV seroprevalence estimates in adult U.S. incarcerated populations and when developing HBV screening and vaccination protocols in correctional settings.

HCV-related mortality among male prison inmates in Texas, 1994-2003.

PURPOSE: The prevalence of hepatitis C virus (HCV) infection is high among adult incarcerated populations, but HCV-related mortality data are lacking. The study purpose was to assess HCV-related mortality over time and across racial/ethnic categories from 1994 through 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ). METHODS: TDCJ decedent data were linked with Texas Vital Statistics multiple-cause-of-death data. Crude annual HCV death rates, age- and race-adjusted summary rates, and average annual percent changes were estimated. The proportion of deaths due to chronic liver disease/cirrhosis, liver cancer, hepatitis B, and HIV for which HCV was identified as an intervening or contributing cause of death was calculated. RESULTS: Among Texas male prisoners, HCV death rates were high and increased over the 10-year study period by an average 21% annually, with the largest increase occurring among Hispanic prisoners. HCV was identified as an intervening or contributing cause of death in 15% of chronic liver disease/cirrhosis deaths, 33% of liver cancer deaths, 81% of hepatitis B deaths, and 7% of HIV deaths. CONCLUSIONS: Because HCV-related deaths among Texas male prisoners are high and increasing, particularly among Hispanics, targeted prevention, screening, and treatment of HCV infections should be among the priorities of U.S. correctional healthcare systems.

Liver cancer mortality among male prison inmates in Texas, 1992-2003.

OBJECTIVES: Prevalence estimates for several liver cancer risk factors-hepatitis C, hepatitis B, and history of alcohol abuse-are substantially higher in U.S. prison populations than in the general population. However, liver cancer mortality data from these populations are lacking. The primary aims of this study were to examine trends in liver cancer mortality rates from 1992 to 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ) and to compare these rates to general population rates. METHODS: TDCJ data on male decedents (N=4026) were linked with Texas Vital Statistics multiple-cause-of-death data. Crude average annual liver cancer death rates, average annual percent changes, and standardized mortality ratios were estimated. RESULTS: Crude liver cancer death rates increased by an average annual 6.1% among male prisoners, which was considerably higher than the average annual percent change among similarly aged males in Texas (2.0%) and the U.S. (2.9%). The number of liver cancer deaths among male prisoners was 4.7 (4.0-5.6) and 6.3 (5.3-7.5) times higher than the expected number of deaths estimated using age-specific rates from these reference populations. CONCLUSIONS: From 1992 to 2003, liver cancer death rates and rate increases were elevated among Texas male prisoners. Findings support previous recommendations for targeted prevention, screening, and treatment of liver cancer risk factors in prison populations.

Screening for traumatic brain injury in an offender sample: a first look at the reliability and validity of the Traumatic Brain Injury Questionnaire.

OBJECTIVE: To assess the reliability and validity of the Traumatic Brain Injury Questionnaire (TBIQ) for assessing history of traumatic brain injury (TBI) in an offender population. SETTING/PARTICIPANTS: Offenders (118 women and 107 men) from 6 federal prison facilities in 3 geographic regions. MEASURES: TBIQ and multiple measures of cognitive and behavioral functioning. RESULTS: Preliminary results indicated good test-retest reliability for lifetime history of head injury, good internal consistency for symptom severity and frequency scales, and good criterion validity for frequency of head injury and frequency and severity of symptoms. CONCLUSION: The TBIQ holds promise as an instrument for the assessment of TBI history in offender populations.