Individual and Combined Effect of Diabetes and Lifetime Criminal Justice Involvement on Healthcare Utilization in US Adults, 2015–2019

• Published in: Journal of general internal medicine : JGIM 2022-05, Vol.37 (7), p.1688-1696
• Main Authors: Hawks, Laura C., Walker, Rebekah J., Egede, Leonard E.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Crime; Criminal Law; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Health care; Health risks; Health services utilization; Humans; Internal Medicine; Judicial system; Medicine; Medicine & Public Health; Original Research; Patient Acceptance of Health Care; Risk analysis; Risk factors; Substance-Related Disorders - epidemiology; Utilization
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-021-07218-1

Background Diabetes and criminal justice involvement (CJI) are both associated with poor health outcomes and increased healthcare utilization. However, little is known about the additive effects of these risk factors when combined. This study examined the individual and combined effects of diabetes and CJI on healthcare utilization. Methods Data from the National Survey of Drug Use and Health (2015–2019) was used to create a cross-sectional, nationally representative sample of US adults with diabetes, CJI, combination of both, or neither. Negative binomial regression was used to test the association between those with CJI and diabetes (compared to diabetes alone) and three utilization types (outpatient, ED, and inpatient) controlling for relevant sociodemographic and clinical covariates. Results Of 212,079 respondents, representing 268,893,642 US adults, 8.8% report having diabetes alone, 15.2% report having CJI alone, and 1.8 % report both diabetes and lifetime CJI. After adjustment, those with diabetes and CJI had increased acute care utilization compared to those with diabetes alone (ED visits: IRR 1.13; 95% CI 1.00–1.28; nights hospitalized: IRR 1.34; 95% CI 1.08–1.67). There was no difference in outpatient utilization between those with both diabetes and CJI compared to those with diabetes alone (IRR 1.04, 95% CI 0.99–1.10). Conclusion Individuals with complex social and health risks such as diabetes and lifetime CJI experience increased acute healthcare utilization but no difference in outpatient utilization. Tailored interventions that target both diabetes and CJI are needed to reduce unnecessary utilization in this population.