Physical health outcomes in prisoners with intellectual disability: a cross-sectional study.
Prisoners with ID enter with more heart disease and obesity yet get less preventive care—screen at intake and plug the gap before release.
01Research in Context
What this study did
Researchers asked a simple question: are prisoners with intellectual disability (ID) sicker than other prisoners?
They gave a quick ID screen to everyone entering prisons in one region. Then they compared health records of those who screened positive with those who did not.
The team looked for heart disease, hearing trouble, obesity, and whether anyone had received preventive care like blood-pressure checks.
What they found
Prisoners who screened positive for ID had higher odds of heart disease, hearing problems, and obesity.
They also received less preventive care. The pattern held after adjusting for age and sex.
How this fits with other research
The bad-health gap is not unique to prisons. Haider et al. (2013) found the same deficits in Australian adults with ID living at home.
But the gap can be closed. S-Eisenhower et al. (2006) ran a one-off ID-tailored health screen in the community and doubled the number of new health needs that were actually met within a year.
Van Hanegem et al. (2014) later showed that removing cost and travel barriers pushed cardiovascular-screening uptake from about 20 % to over 90 % among adults with ID.
Together these papers form a ladder: first you spot the deficit, then you prove a screen works, then you show how to make it stick.
Why it matters
If you work in criminal-justice or transitional services, add an ID screen at intake. Flag positive cases for a nurse-led health check before release. Use the S-A screen or the E model—both are free to copy. Closing health gaps before the gate opens cuts later crisis visits and saves money.
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02At a glance
03Original abstract
BACKGROUND: People with intellectual disability (ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. METHODS: Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. RESULTS: Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). CONCLUSIONS: Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01621.x