Racial disparities in traumatic injuries sustained in prison: A multicenter retrospective cohort study

Incarcerated individuals experience elevated injury rates, yet data on their injuries-particularly by race-are limited. This study aimed to describe racial differences in the occurrence, characteristics, and outcomes of traumatic prison injuries.

This retrospective cohort study included adult trauma patients admitted to five Level I trauma centers (01/2016-07/2022). Patients were categorized as non-Hispanic (NH-) White, Black, or Hispanic. The primary outcome was the proportion of prison injuries among all traumatic injuries. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) admission, and discharge disposition.

Among 53,872 trauma admissions, 187 (0.35%) occurred in prison. Black (0.8%) and Hispanic (0.4%) patients had a higher proportion of prison injuries than NH-White patients (0.3%) (p < 0.0001). After adjustment, Black [OR:2.34 (1.50-3.67)] and Hispanic patients [OR:1.44 (1.02-2.03)] had higher odds of sustaining prison injuries than NH-White patients. There was a trend towards Black patients suffering assaults more than Hispanic or NH-White patients (p = 0.06). NH-White patients (19.3%) sustained self-harm injuries significantly more than Black patients (0%), with no difference compared to Hispanic patients (10%). ICU admission was similar by race. Differences were observed in LOS and discharge disposition, Hispanic patients had the longest stays.

Black and Hispanic patients had higher odds of having a prison injury than NH-White patients. NH-White patients suffered self-harm more than Black patients, whose most common cause of injury was assault. Differences in injury and discharge patterns suggest potential structural inequities in prisons and discharge practices.