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The Associations Between Medical and Mental Health Conditions and Health Care Utilization in US Adults with Past-Year Criminal Legal Involvement

  • Original Research
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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Every year, millions of US adults return home from prison or jail, and they visit the emergency department and experience hospitalizations at higher rates than the general population. Little is known about the primary conditions that drive this acute care use.

Objective

To determine the individual and combined associations between medical and mental health conditions and acute health care utilization among individuals with recent criminal legal involvement in a nationally representative sample of US adults.

Design

We examined the association between having medical or mental, or both, conditions (compared to none), and acute care utilization using negative binomial regression models adjusted for relevant socio-demographic covariates.

Participants

Adult respondents to the National Survey of Drug Use and Health (2015–2019) who reported past year criminal legal involvement.

Main Measures

Self-reported visits to the emergency department and nights spent hospitalized.

Results

Among 9039 respondents, 12.4% had a medical condition only, 34.6% had a mental health condition only, and 19.2% had both mental and medical conditions. In adjusted models, incident rate ratio (IRR) for ED use for medical conditions only was 1.32 (95% CI 1.05, 1.66); for mental conditions only, the IRR was 1.36 (95% CI 1.18, 1.57); for both conditions, the IRR was 2.13 (95% CI 1.81, 2.51). For inpatient use, IRR for medical only: 1.73 (95% CI 1.08, 2.76); for mental only, IRR: 2.47 (95% CI 1.68, 3.65); for both, IRR: 4.26 (95% CI 2.91, 6.25).

Conclusion

Medical and mental health needs appear to contribute equally to increased acute care utilization among those with recent criminal legal involvement. This underscores the need to identify and test interventions which comprehensively address both medical and mental health conditions for individuals returning to the community to improve both health care access and quality.

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Funding

Effort for this study was partially supported by the National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede; 1K23DK132505-01A1, PI: Hawks), the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker), and the American Diabetes Association (1-19-JDF-075, PI: Walker). The authors of this paper report no financial disclosures.

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Authors and Affiliations

  1. School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Maria D. Jue BS

  2. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA

    Maria D. Jue BS, Laura C. Hawks MD, MPH, Rebekah J. Walker PhD, Olaitan Akinboboye MBChB, Abigail Thorgerson MPH & Leonard E. Egede MD, MS

  3. Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Laura C. Hawks MD, MPH, Rebekah J. Walker PhD & Leonard E. Egede MD, MS

  4. Institute of Health and Equity, Milwaukee, WI, USA

    Olaitan Akinboboye MBChB

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  1. Maria D. Jue BS
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  6. Leonard E. Egede MD, MS
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Correspondence to Leonard E. Egede MD, MS.

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Jue, M.D., Hawks, L.C., Walker, R.J. et al. The Associations Between Medical and Mental Health Conditions and Health Care Utilization in US Adults with Past-Year Criminal Legal Involvement. J GEN INTERN MED 39, 77–83 (2024). https://doi.org/10.1007/s11606-023-08362-6

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  • DOI: https://doi.org/10.1007/s11606-023-08362-6

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