MORBIDITY AND MORTALITY IN NJDOC SYSTEM

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1 MORBIDITY AND MORTALITY IN NJDOC SYSTEM Jeff Dickert, PhD Chief Operating Officer Arthur Brewer, MD Statewide Medical Director University Correctional Health Care University Behavioral Health Care Biomedical and Health Sciences

2 Disclosure Statement We have no actual or potential conflict of interest in relation to this presentation. The Data Sources for this Analysis are from: UCHC s Quality Improvement Data, NJ Health Statistics, 2014 & NJDOC s Offender Statistics from their Public Website Additional Contributors to this work are: Lisa DeBilio, PhD, Director of Quality Improvement, UCHC Lorraine Steefel, DNP, Nurse Training, edited draft paper Anthony Tamburello, MD, Asst. Director of Psychiatry, provided editorial comments

3 Morbidity and Mortality in Prison Aging Process: Said to accelerate among the incarcerated 1-5 Odds of Chronic Medical Conditions Report by Inmates (Binswanger, 2009) 1.17x Hypertension 1.34x Asthma 1.66x Arthritis 4.82x Cervical Cancer 4.23x Hepatitis Equivalent for Diabetes, Angina, Heart Attacks Lower Odds for Obesity 6

4 Higher Disease Burden in Prisons? Jail and prison inmates had a higher burden of most chronic medical conditions than the general population even with adjustment for important socio-demographic differences and alcohol consumption. Binswanger, et al 6

5 Prison Mortality Rates: Is it Higher or Lower than General Population? BJS s Mortality Rates in Prison per 100,000 7 :

6 Are these Rates Lower than in General Population? FOR IMMEDIATE RELEASE SUNDAY, JANUARY 21, Office of Justice Programs Contact: Stu Smith Phone: (202) DEATH RATES LOWER IN STATE PRISONS THAN IN THE GENERAL POPULATION Nine in Ten Deaths Due to Illness From 2001 to 2004, 99% of State prisoners were between ages 15 and 64. When compared to mortality rates for U.S. residents in this age group, the overall mortality rate of State prisoners was 19% lower during this period. 8

7 Mortality and Age If inmates are sicker, wouldn t it follow they would have at least as high of mortality rates as the general population. However, the prison population has a disproportionate share of younger individuals and fewer females than the general population. Could this account for BJS s observation of lower mortality rates?

8 Age Grouping of Gen Pop v Prisons > Age Grouping of NJ Inmates - 1,000 2,000 3,000 4,000 5,000 Female Pop Male Pop

9 National Incarceration Rates by Age

10 NJDOC s Observation NJ Department of Health makes available mortality rates for the following discrete groupings: Age groupings identified by NJDOC Statistics Race/ethnicity groupings (African American, Hispanic, Caucasian Excluding Hispanic) Sex - NJ Health Statistics, This permitted prediction of Mortality Rates for this unique population groupings within NJDOC based on NJ Health Statistics, 2004

11 Actual New Jersey Anticipated Number of Deaths Compared to Actual when Using NJ Health Statistics for 2004 Predicted when Excluding Accidents and Homicides: 79 per year (87 if include Accidents & Homicides)

12 Lower Mortality Rates in NJ DOC Through this Analysis 38% Lower Mortality Rates in NJ Prisons Compared to Prediction based upon NJ Mortality Rates in NJ s General Population in 2004

13 Prior to Age 50 Much Lower Risk of Death in NJDOC Compared to General Population Age Predicted based on NJ Health Statistics 2004 NJDOC Actual 3 Year Avg Deaths >

14 Limitations of this Comparison in Mortality Rates Mortality Rates have been decreasing approximately 1% per year in the general population between 1969 and Case, et al. documents a 8.8% increase in mortality for midage, white, non-hispanic men and women in the United States between 1999 and 2013, mainly as a result of increases in drug and alcohol poisoning, suicide, and chronic liver diseases and cirrhosis. 12

15 Causes of Death NJ & BJS 10 *includes liver cancer Years Cancer Heart Disease Liver Disease Respiratory Disease AIDS Related All Other Suicides Drug/Alcohol Intoxication Accidents Homicides thru Sept Total NJ Annual Rate/100K * BJS Rates for US Prisons

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17 Morbidity Rates in NJDOC from Medical Records Diseases with Higher Rates in Prisons HIV: NJDOC %; Gen Pop 0.38% Times Hep C: NJDOC 7.2%; Gen Pop 0.85% Times

18 Diseases Comparable or Lower than General Population Diabetes: Rate of 2011 NJ Population with Diabetes 15 Age Group <45 4.9% % % % 85 Expected Numbers in NJDOC 2015 Total Expected 1,358 Actual Cases within NJDOC: 1,365

19 Age Group Hypertension: Rate of US Population 2010 with Hypertension 16 Expected NJDOC Numbers 2015 <45 9.8% 1, % 1, % 274 Total Expected 3,816 Actual Cases within NJDOC: 2,821

20 Asthma NJ Department of Health prevalence rate of 8.83% for asthma in adults over 18 which would be 1,897 in NJDOC 17 Actual Cases in NJDOC 1,585

21 Percent of Population with 1 or More Chronic Diseases National Rates : 27% 45-64: 63% 65 : 86% Or: 7,758 Actual cases in NJDOC with one or more Chronic Diseases: 7,854

22 Clinics NJDOC Chronic Care Clinics Enrolled 2015 Rate Cardiology 4, % Endocrinology 1, % Oncology % General % Infectious Disease 1, % Neurology % Pulmonology 1, %

23 Conclusions Mortality: Prisons have a protective factor Most likely as a result of universal screening and access to treatment especially for the younger population Morbidity: HIV and Hep C Much Higher than Gen Pop Most likely as a result of prior drug abuse Other Chronic Diseases: No Evidence within NJDOC to Support Higher Rates based upon Individuals Identified by the Medical Providers

24 REFERENCES 1. Anno, B.J., Graham, C., Lawrence, J.E., Shansky, R. et al., (2004). Correctional health care: Addressing the needs of elderly, chronically ill, and terminally ill inmates, Washington, DC: U.S. Department of Justice, National Institute of Corrections. 2. Aday, R.H. (2003). Aging prisoners: Crisis in American corrections. Westport, CT: Praeger Publishers. 3. Loeb, S.J., Abudagga, A. (2006). Health-related research on older inmates: An integrative review. Res Nurs Health, 29, 6, Williams, B., & Abraldes, R., (2007). Growing older: Challenges of prison and reentry for the aging population. In R. Greifinger (Ed.), Public health behind bars: From prisons to communities. New York: Springer. 5. Chammah, M. (2015). Do you age faster in prison? Science tries to catch-up with the problem of Accelerated Aging. The Mashall Project Retrieved from 6. Binswanger, I.A., Krueger P.M., & Steiner J.F. (2009). Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. J Epidemiol Community Health; 63, 11, Noonan, M., Rohloff, H., & Ginder, S.(2015, Aug.). Mortality in local jails and state prisons, Statistical Tables. Retrieved from: 8. Department of Justice. (2007, Jan. 21). Death rates lower in state prisons than in the general population. Retrieved from: 9. New Jersey Health State Department of Health (2015). New Jersey Health Statistics Retrieved from: Retrieved from: Ma, J., Ward, E., Siegel, R., Jemal, A. Temporal trends in mortality in the United States, Journal of the American Medical Association. 314, 16, Case, A., Deaton, A. Rising morbidity and mortality in midlife among white, non-hispanic Americans in the 21 st century. Proceedings of the National Academy of Sciences of the United States of America. Published ahead of print: November 2, 2015, 1-6.

25 REFERENCES 13.Retrieved from: 14.Retrieved from: 15.Retrieved from: 16.Retrieved from: 17.Retrieved from: 18.Ward, B.W., Schiller, J.S., Goodman, R.A. (2014). Multiple chronic conditions among U.S. adults: A 2012 update. Retrieved from:

26 Impact of Health Care for All Inmates in NJ's Prison plus Ban on Smoking Results in Mortality Rates Approximately 40% Lower than Community Anticipated Mortality Rates within NJDOC based on NJ 2004 Death Rates per 100,000 NJDOC's Race/Ethnicity** Age Groups Male Pop Rate/ 100,000 When Factoring Age, Sex, Ethnicity/Race* Anticipated Mortality Rates for Males Based Upon NJDOC Population January 2015* 61% - African American Anticipated Deaths 16% - Hispanic Rate/ 100,000 Anticipated Deaths 23% Caucasian Rate/ 100,000 Anticipated Deaths , , , , , , , , , , > Total 20,

27 Race/Ethnicity** 61% - African American 16% - Hispanic 23% Caucasian Female Pop Rate/ 100,000 Anticipated Deaths Rate/ 100,000 Anticipated Deaths Rate/ 100,000 Age Groups Anticipated Mortality Rates for Females Based Upon NJDOC Population January 2015* NJDOC's Anticipated Deaths >64 Total Female**** Blacks Hispanic White Total Anticipated Deaths by Race Total Anticipated Deaths within NJDOC based on NJ 2004 Death Rates 86.80