Differences in Hospitalization and Inpatient Death Patterns by Incarceration Status in 31 US Jurisdictions, 2021

Population-based studies that examine both hospitalization and inpatient death patterns by incarceration status are sparse. We sought to compare hospitalization and inpatient death patterns by incarceration status in the United States.

In this retrospective study of adults aged 18 to 64 years, we used the 2021 State Inpatient Database files from 31 US jurisdictions, which included discharges from general acute care hospitals. We compared hospitalization and inpatient death patterns among incarcerated adults versus nonincarcerated adults using adjusted rate ratios (ARRs) and 95% CIs, estimated with negative binomial regression. We examined discharges overall and discharges by nonoverlapping hospital service line.

The study population included 6.3 million hospital discharges (incarcerated, 1.1%; mean [SD] age, 47.5 [12.7] y; women, 46.8%; non-Hispanic White race and ethnicity, 36.6%), with 2.2% inpatient deaths. For discharges overall, incarcerated adults had higher rates of hospitalization (ARR = 2.9; 95% CI, 2.2-3.8) than nonincarcerated adults, which was driven mainly by higher rates of inpatient admissions classified as mental health/substance use (ARR = 11.8; 95% CI, 8.5-16.8) and injury (ARR = 1.9; 95% CI, 1.6-2.2) among incarcerated adults than among nonincarcerated adults. However, surgical (ARR = 0.6; 95% CI, 0.5-0.6) and medical (ARR = 0.8; 95% CI, 0.7-0.9) admissions were lower among incarcerated adults than among nonincarcerated adults. Overall, incarcerated adults had lower inpatient mortality during their length of stay (ARR = 0.4; 95% CI, 0.4-0.5) than nonincarcerated adults, which was consistent by hospital service line.

Considering hospitalization and mortality together offers a clear view of health care use among incarcerated adults and underscores the need for integrated correctional-hospital data systems to inform public health practice and policy.