gnrh agonist In this paper we show
In this paper, we show that prisoners report worse health than their noninstitutionalized counterparts. Incarceration is associated with a higher prevalence of hypertension, diabetes, heart problems, asthma, kidney problems, stroke, arthritis, and STI, with differences larger for whites than blacks, especially among women. Some support is found for the main hypothesis that race disparities are muted in prisons than the general community. After adjusting for age and education, we find that male prisons have smaller black-white disparities for kidney problems, stroke, and arthritis compared to men in the general population. For women the hypothesis is supported for hypertension, diabetes, heart problems, kidney problems, and stroke. Black-white disparities are actually larger in prisons for obesity among both men and women and for STI for men. Overall, these findings are consistent with previous studies (Binswanger et al., 2009; Binswanger et al., 2010; Harris, Hek, & Condon, 2007; Wilper et al., 2009); however, our study provides further confirmation by stratifying by both sex and race among U.S. prisoners. This study demonstrates that the poor health documented among prisoners is not necessarily due to the overrepresentation of people of color within prisons. These results provide evidence that the selection of more unhealthy persons into prisons is only moderately stronger among white compared to black men but noteworthy among white compared to black women. At the beginning of the paper we noted several mechanisms that contribute to health disparities. Specific morbidities, however, are more likely than others to respond to these mechanisms. While the mechanisms for health disparities are not directly tested in this paper, we can discuss the findings in light of current knowledge. For instance, neighborhood environmental exposures are best characterized by cancer and gnrh agonist and we see that patterns of disparities are nearly identical in and out of prison. The only exception is disparities in cancer among female inmates in which the gap between white and black women is wider in prisons, with white women having higher odds of cancer. Similarly, arthritis—a leading cause of disability in the United States (CDC, 2016)—is likely unrelated to imprisonment per se and the only significant difference found in patterns of disparities is among male prisoners. On the other hand, hypertension, heart problems, and stroke are the most proximate morbidities linked to stress and discrimination. Changes in the links between race and health in this domain would shed light on health disparities. The findings show that among women in the noninstitutionalized population, blacks have significantly higher odds of reporting hypertension, heart problems, and stroke compared to whites on the order of 1.74–2.36 times as high. Among women in the prison population, however, the black-white disparity is significantly reduced for hypertension and reversed for heart problems and stroke so that white women have significantly higher odds of reporting these conditions compared to black women. Among men, only the black-white disparities for stroke is reversed in prisons. The mechanisms linking stress and physical health appear to operate differently in prisons, in general, at least among women, suggesting incomplete understanding of stress and health. Importantly, hypertension and diabetes are leading risk factors for kidney disease, which effects about 10% of the U.S. population (CDC, 2014) and is the 9th leading cause of death in the U.S. (Kochanek, Murphy, Xu & Tejada-Vera, 2016). Individuals who advance to kidney failure require regular dialysis or kidney transplantation—expensive costs for correctional institutions. African Americans have three times the risk of developing kidney disease compared to non-Hispanic whites in the noninstitutionalized population, but in prisons, this disparity is reversed. Diabetes, obesity, and STI are sensitive to lifestyle factors such as sexual practices, nutrition, and exercise. Therefore, we might expect to see diminished disparities in prison because these behaviors are neutralized among inmates. But obesity and STI are the exact opposite for black men as well as STI for black women (the disparities are worse in prison). Contagion theory and a social network perspective (Christakis & Fowler, 2012) may help explain this pattern. For example, research on HIV transmission among prisoners demonstrates that the prison itself is a high risk setting for transmission of HIV/AIDS due to high-risk sexual activity (both consensual and nonconsensual), injection drug use, and tattooing (Blackenship, Smoyer, Bray, & Mattocks, 2005; Krebs, 2006; Krebs & Melanie, 2002; Okie, 2007). There are, however, uncertainties about the extent and the nature of infectious disease transmission within prisons (Hammett, 2006). Nevertheless, disparities in HIV/AIDS are likely due to the fact that blacks have a greater likelihood of being exposed to the prison environment and then return to their communities (Blackenship et al., 2005). Mass incarceration is concentrated in prison “feeder communities” (Drucker, 2011). For example, the Justice Mapping Center found that in the state of New York 75% of the entire prison population came from only seven neighborhoods in New York City characterized by poverty and a high proportion of racial/ethnic minorities (Drucker, 2011). The serial incarceration that is characteristic of these neighborhoods disrupts social networks and increases the transmission of HIV/AIDS in these communities (Drucker, 2011). Laumann & Youm (1999) posit that the higher rates of STIs among African Americans is partly explained by an intra racial network effect: compared to white sexual partner choices, black choices are more segregated (limited to other blacks) and dissortative (sexually inexperienced individuals are more likely to interact with much more experienced sexual partners). This intra racial network effect may be more pronounced for blacks who contract STIs in prison and then return to their community-based social networks. Contagion processes may also operate for obesity (Christakis & Fowler, 2007; see Cohen-Cole & Fletcher, 2008 for a critique).