Adverse health outcomes in violent crime convicted persons: risk factors for somatic inpatient healthcare utilization

Violent Crime Convicted Persons (VCCPs) are at increased risk of somatic health problems over the life course. However, the topic remains insufficiently studied, particularly regarding interactions with healthcare services in high-risk groups over extended periods. This prospective study aimed to explore adverse somatic outcomes in young adult VCCPs with a history of imprisonment and their interactions with healthcare services in Sweden.

In the Development of Aggressive Antisocial Behavior Study (DAABS) cohort, male VCCPs aged 18-25 (n = 266) imprisoned for violent and/or 'contact sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries throughout 2017. Information regarding somatic inpatient healthcare utilization (HCU), somatic morbidity, and prescribed drug use was tracked and compared with a general population comparison group (n = 10,000). Baseline risk factors were used to explore prospective somatic inpatient HCU in VCCPs.

The DAABS cohort exhibited higher rates of both somatic outpatient (IRR = 1.8 [1.6-2.5]) and inpatient (IRR = 3.3 [2.2-4.9]) healthcare utilization compared with the general population group. They also showed a higher cumulative incidence of injuries of all types (IRR = 3.1 [2.4-4.0]), as well as ambulatory care sensitive conditions (ACSCs) (IRR = 2.2 [1.5-3.2]). Increased rates of prescription drug use were observed for nervous and respiratory systems, whereas reduced rates were especially noted in drugs used for the alimentary tract and metabolism as well as blood and blood forming organs. The DAABS cohort exhibited a severely elevated risk of all-cause mortality (HR 16.1 [9.4-27.8]). Low educational attainment decreased the incidence rate, while foster home placement and the assignment to a persistent offending trajectory increased the incidence rate of somatic inpatient HCU within the cohort.

The VCCP cohort exhibited atypical patterns of somatic healthcare utilization, characterized by elevated inpatient and outpatient use, high rates of ACSCs and injuries, and a strikingly increased risk of premature mortality compared with the general population. The atypical nature of this utilization, reflected in the elevated incidence of ACSCs, underscores the need to improve understanding of the group's HCU patterns and the potential barriers to primary care. Enhancing health literacy and reducing barriers to timely and appropriate care are essential steps toward mitigating adverse health outcomes and promoting healthcare equity in this vulnerable population.