Colorectal and Breast Cancer Screening Status for People in Ontario Provincial Correctional Facilities.

INTRODUCTION: Primary care represents an opportunity to improve health for people who experience imprisonment, and screening for colorectal and breast cancer indicate primary care quality. The study objectives were to examine the proportion of people released from provincial correctional facilities who were overdue for colorectal or breast cancer screening on admission to the correctional facility and who were still overdue after 3 years, and to compare findings with data for the general population. METHODS: Administrative data were used to identify people eligible for colorectal and breast cancer screening who were released from provincial correctional facilities in 2010 (N=3,803 and N=249, respectively) and in the general population (N=2,757,584 and N=1,099,942, respectively) in Ontario, Canada. Chi-square tests and log binomial regression models were used to compare the proportion of individuals overdue for screening on admission or on July 1, 2010 for the general population, and still overdue after 3 years. Analyses were conducted in 2017 and 2018. RESULTS: Compared with the general population, people in the corrections group were 1.53 times (95% CI=1.50, 1.55) more likely to be overdue for colorectal cancer screening: 77.1% (95% CI=74.3, 79.9) vs 50.5% (95% CI=50.5, 50.6), and 2.25 times (95% CI=2.06, 2.46) more likely to be overdue for breast cancer screening: 65.9% (95% CI=56.2, 76.8) vs 29.3% (95% CI=29.2, 29.4, both p<0.001). They were also more likely to still be overdue 3 years later: 62.6% (95% CI=60.1, 65.2) vs 33.6% (95% CI=33.5, 33.6) for colorectal cancer and 52.2% (95% CI=43.6, 62.0) vs 20.2% (95% CI=20.1, 20.3) for breast cancer (both p<0.001). CONCLUSIONS: People who experience imprisonment are less likely than the general population to access colorectal and breast cancer screening. This suggests the need to strengthen primary care for this population. Specifically, efforts should be made to improve access to colorectal and breast cancer screening, through health promotion, program delivery, and linkage to community services while in correctional facilities.

Cervical Cancer Screening Access for Women Who Experience Imprisonment in Ontario, Canada.

Importance: Women who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence. Objectives: To determine cervical cancer screening rates for women in provincial prison in Ontario, Canada, and to compare these data with data for the general population. Design, Setting, and Participants: This retrospective cohort study used correctional and health administrative data from January 1, 2006, to December 31, 2013. Participants included Ontario women aged 21 to 69 years during the follow-up period with no history of cervical cancer or hysterectomy. Analyses were conducted between July 2017 and September 2018. Exposures: Women admitted to Ontario provincial prison in 2009 or 2010 and released in 2010 were considered exposed, and women in the general population of Ontario were considered unexposed. Main Outcomes and Measures: Whether women were overdue for cervical cancer screening at the time of admission to prison or on July 1, 2010, for the general population, defined as not having been screened in the previous 3 years, and whether women who were overdue were still overdue after 3 years. Results: There were 4553 women in the prison group and 3 647 936 women in the general population group. The median (interquartile range) age was 36 (29-43) years in the prison group and 43 (34-53) years in the general population. Women in the prison group had 2.20 times (95% CI, 2.08-2.33) the odds of being overdue for cervical cancer screening compared with women in the general population after adjusting for neighborhood income quintile, at 53.9% (95% CI, 51.8%-56.1%) compared with 32.9% (95% CI, 32.8%-33.0%) (P < .001). Women in the prison group also had nearly twice the odds of still being overdue at 3 years, with an odds ratio of 1.87 (95% CI, 1.76-1.99) after adjusting for neighborhood income quintile, and rates of still being overdue of 36.2% (95% CI, 34.5%-38.0%) compared with 21.9% (95% CI, 21.8%-21.9%) (P < .001). Conclusions and Relevance: Women who experience imprisonment have worse cervical cancer screening access than women in the general population. Work should be done to promote cervical cancer screening awareness and to improve access to acceptable screening in prison and in the community after prison release.

Do people who experience incarceration age more quickly? Exploratory analyses using retrospective cohort data on mortality from Ontario, Canada.

OBJECTIVES: We aimed to explore whether mortality data are consistent with the view that aging is accelerated for people with a history of incarceration compared to the general population, using data on mortality rates and life expectancy for persons in Ontario, Canada. METHODS: We obtained data from the Ontario Ministry of Community Safety and Correctional Services on all adults admitted to provincial correctional facilities in Ontario in 2000, and linked these data with death records from provincial vital statistics between January 1, 2000 and December 31, 2012. We used life table methods to calculate mortality rates and life expectancies for this cohort by sex and 5-year age group. We similarly generated population comparison rates using publicly available data for the general population of Ontario in 2006 as the midpoint of the follow up period. We compared these mortality indices between the 2000 Ontario prison cohort and the general population by age group and sex. RESULTS: The difference in all-cause mortality rates between the 2000 Ontario prison cohort and the general population was greatest for younger adults, with the prison cohort experiencing rates of death that would be expected for persons at least 15 years older at ages 20 to 44 for men and ages 20 to 59 for women. Life expectancy in the 2000 Ontario prison cohort was most similar to life expectancy of persons five years older in the general population at age intervals 20 to 45 in men and 20 to 30 in women. CONCLUSIONS: For most of adulthood, life expectancy and mortality rates are worse for adults with a history of incarceration than for the general population in Ontario, Canada. However, the association between mortality and incarceration status is modified by age, with the greatest relative burden of mortality experienced by younger persons with a history of incarceration and modified by sex, with worse relative mortality in women. Future research should explore the association between incarceration status and markers of aging including mortality, morbidity and physical appearance.