Prison primary care and non-communicable diseases: a data-linkage survey of prevalence and associated risk factors

BACKGROUND: The size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations. AIM: To explore both the prevalence of NCDs and their risk factors. DESIGN & SETTING: A cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England. METHOD: Self-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records. RESULTS: It was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence. The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001). CONCLUSION: Compared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high. Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence.