Incarceration as a key variable in racial disparities of asthma prevalence.
BACKGROUND
Despite the disproportionate incarceration of minorities in the United States, little data exist investigating how being incarcerated contributes to persistent racial/ethnic disparities in chronic conditions. We hypothesized that incarceration augments disparities in chronic disease.


METHODS
Using data from the New York City Health and Nutrition Examination Study, a community-based survey of 1999 adults, we first estimated the association between having a history of incarceration and the prevalence of asthma, diabetes, hypertension using propensity score matching methods. Propensity scores predictive of incarceration were generated using participant demographics, socioeconomic status, smoking, excessive alcohol and illicit drug use, and intimate partner violence. Among those conditions associated with incarceration, we then performed mediation analysis to explore whether incarceration mediates racial/ethnic disparities within the disease.


RESULTS
Individuals with a history of incarceration were more likely to have asthma compared to those without (13% vs. 6%, p < 0.05) and not more likely to have diabetes or hypertension, after matching on propensity scores. Statistical mediation analysis revealed that increased rates of incarceration among Blacks partially contribute to the racial disparity in asthma prevalence.


CONCLUSIONS
Having been incarcerated may augment racial disparities in asthma among NYC residents. Eliminating health disparities should include a better understanding of the role of incarceration and criminal justice policies in contributing to these disparities.
Section of General Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. emily.wang@yale.edu
Emily A
EA
Wang
Jeremy
J
Green
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology*; D002908:Chronic Disease; D003625:Data Collection; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011329:Prisoners / Q000523:psychology*; D012307:Risk Factors; D055815:Young Adult