Adulthood Health Insurance Source for Previous Criminal Legal System Involved Pediatrics

To test the effects of criminal legal system (CLS) involvement during adolescence on health insurance enrollment source during adulthood.

The National Longitudinal Survey of Youth-1997 (NLSY97) is a United States birth cohort study used to conduct our current study. Three discrete treatment groups were created: youth arrested before age 18, youth incarcerated in juvenile facilities before age 18, and youth incarcerated in adult facilities before age 18. The control group included youth with no CLS contact before age 18. Gradient boosted inverse probability weighting (IPW) was used to decrease the differences between the groups across potential confounders. The primary outcome for the current study was participants' health insurance source as an adult (2005 to 2021): no health insurance, Medicaid insurance, employer-provided insurance, family member provided insurance, self-purchased insurance, and other insurance policies.

The NLSY97 is a secondary data source collected from 1997 to 2021. Of the initial sample of 9907 eligible individuals, 8984 (90.7%) individuals participated in the NLSY97, and 7826 individuals were included in the current study.

The analytical sample was 50.5% male, 57.7% white, 27.8% Black, and aged from 12 to 41 during the study period. Being arrested (b = 0.241, p < 0.001, IRR 95% CI = 1.249,1.295; b = 0.261, p < 0.001, IRR 95% CI = 1.264,1.332), incarcerated in a juvenile facility (b = 0.403, p < 0.001, IRR 95% CI = 1.466,1.528; b = 0.431, p < 0.001, IRR 95% CI = 1.489,1.590), or incarcerated in an adult facility (b = 0.616, p < 0.001, IRR 95% CI = 1.816,1.890; b = 0.337, p < 0.001, IRR 95% CI = 1.355,1.447) before age 18 was associated with an increased number of years without health insurance and Medicaid insurance (respectively).

This study highlights that youth involved in the CLS before age 18 might rely on Medicaid insurance or possess no health insurance during adulthood, highlighting the importance of state-run medical insurance programs for this population.