Chronic conditions such as type 2 diabetes, asthma, HIV infection, and mental illness may be greatly undertreated in the United States jail and prison population, according to a new study.

For their analysis, the researchers used national health survey data covering 2018 to 2020 to estimate rates of chronic conditions among recently incarcerated people, and a commercial prescription database to estimate the distribution of medication treatments to the jail and prison population. Their analysis suggests that for many common and serious conditions, incarcerated people are substantially less likely to be treated compared to the general US population.

The study finds that recently incarcerated individuals with type 2 diabetes represented about 0.44% of the US burden of the condition, but got only 0.15% of oral anti-hyperglycemic medications—nearly a threefold difference. Incarcerated individuals with asthma accounted for 0.85% of the total US asthma population, but just 0.15% of asthma treatment volume, a more than fivefold difference.

The study appears in JAMA Health Forum.

“Our findings raise serious concerns about the access to and quality of pharmacologic care for very common chronic health conditions among the incarcerated,” says study senior author G. Caleb Alexander, professor in the epidemiology department at the Johns Hopkins Bloomberg School of Public Health. “We knew going in that the US incarcerated population has a higher prevalence of some chronic diseases. But we were really surprised by the extent of potential undertreatment that we identified.”

Prior studies have found evidence that health care provided to the US incarcerated population—roughly two million individuals—is often understaffed, underfunded, and of poor quality. Yet studying health care issues among the incarcerated involves many challenges. Few studies have examined treatment of common and chronic diseases such as diabetes and asthma.

“Health care provided in jails and prisons is provided by a patchwork of health care providers, most commonly private contractors who do not widely share information about the services they provide to incarcerated people,” says study coauthor Brendan Saloner, an associate professor in the Bloomberg School’s department of health policy and management. “The lack of transparency means that advocates and policymakers have a very incomplete picture of the medicines that are available during a stay in jail or prison.”

The lack of transparency also makes it difficult to research. For their study, the researchers generated two sets of estimates: one for the prevalence of specific conditions among recently incarcerated inmates, the other on the percentage of common chronic illness prescriptions going to jails and state prisons.

Read the full article about health conditions go untreated in prisons at Futurity.