title: Increased hospital and emergency department utilization by individuals with recent criminal justice involvement: results of a national survey.
abstract: BACKGROUND
  Individuals involved with the criminal justice system have increased health needs and poor access to primary care.
  
  
  OBJECTIVE
  To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Non-institutionalized, civilian U.S. adult participants (n = 154,356) of the National Survey on Drug Use and Health (2008-2011).
  
  
  METHODS
  Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey.
  
  
  RESULTS
  An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P < 0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P < 0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures.
  
  
  CONCLUSIONS
  Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA, joseph.frank@ucdenver.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D057237:Criminals; D003430:Cross-Sectional Studies / Q000639:trends; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D055815:Young Adult