IBD care and outcomes for prisoners with IBD: a cohort study

Objective The incidence rate of inflammatory bowel disease (IBD) in England is 37/100 000 patient years. There is limited literature on IBD outcomes in prison populations. We aimed to determine differences in outcomes for patients with IBD who have spent time in prison. Method Prisoners seen in the IBD clinic at our trust were identified electronically. A control cohort (1:2) was selected using the patients from the same clinic in the two neighbouring slots and matched by gender. Demographic, disease-specific and process-based variables, including time from diagnosis to clinic and final clinical contact, were identified. Results A total of 151 male patients with IBD was identified (53 prisoners and 98 controls). Of the imprisoned patients, 24/53 (45%) were newly diagnosed patients, of which two were diagnosed at emergency admission. This demonstrates a prisoner IBD incidence rate to be 88.5/100 000 patient years. 29/53 (55%) were known patients with IBD transferred in services during imprisonment. The median follow-up was 16.9 (IQR 7.4–40.9) months and 48.6 (19.1–112.0) months in the prisoners and controls, respectively. The ‘Did not attend or DNA’ rate was 78.6 per 1000 patient months versus 22.2 (p<0.001), respectively. The incidence rate among prisoners compared with controls for patients transferred in for steroid use was 20.8 per 1000 patient months versus 4.08 (p<0.001), the incidence rate for initiation or switch in advanced therapy was 11.7 vs 2.91 (p=0.004) and the incidence rate for hospital admission was 13.1 vs 3.2 (p=0.002). Conclusion There was a higher frequency of steroid use, initiation or switch in advanced therapy and hospital admission in prisoners, suggesting greater treatment needs. These findings warrant further investigation.