The Long Shadow of Incarceration: The Association of Incarceration History With Self-Reported Health Among Older...

The United States has one of the highest incarceration rates in the world. Prior incarceration is associated with adverse health effects. While the era of "mass incarceration" began in 1973, little work has focused on older adults, whose lives have spanned the five decades of mass incarceration.

We conducted a cross-sectional analysis using data on adults 50 or older from the nationally representative Family History of Incarceration Survey to test the independent association between prior incarceration and self-reported physical and mental health. In logistic regression models, we controlled for age, gender, race/ethnicity, education, income, employment, and marital status. We also tested for effect modification by race/ethnicity, gender, and time since last incarceration, as well as financial and social wellbeing.

Among 1318 older adults, 21% had been incarcerated. Formerly incarcerated older adults were more likely to be men; non-Hispanic Black or "other" race/ethnicity; meet criteria for disability; be unmarried; and have lower income and education compared with those never incarcerated. In fully adjusted models, prior incarceration was independently associated with greater odds of reporting "fair" or "poor" physical health (aOR:1.88, 95% CI: 1.19-2.98; p = 0.007). Prior incarceration was associated with reporting "fair" or "poor" mental health after adjusting for demographic covariates (aOR: 2.12, 95% CI: 1.24-3.65; p = 0.006) but was nonsignificant after adding socioeconomic covariates. Length of time from last incarceration did not moderate the observed association, meaning that even those incarcerated > 10 years ago had poor self-reported health. Financial wellbeing moderated the association between incarceration and mental health.

Prior incarceration is a social determinant of health for older adults, even those with distant incarceration history, and is strongly associated with current poverty and meeting criteria for disability. Further research is needed to understand the mechanisms of these associations and means to mitigate health harms associated with prior incarceration.