The risk of non-communicable disease in people who have experienced imprisonment

Abstract Introduction Imprisonment is associated with increased infectious disease and poor mental health, but risks of non-communicable diseases (NCDs) are unclear. We conducted a systematic review to describe the incidence of NCDs among people who have experienced imprisonment compared to the general population in high-income countries. Methods We searched four databases for comparative studies of NCD incidence. Reviewers conducted independent risk of bias (RoB) assessment using an adapted version of the Newcastle-Ottawa Scale, with data extraction checked independently. Data were synthesised using random-effects meta-analyses and vote counting based on effect direction. Heterogeneity was investigated using meta-regression and subgroup analysis. Findings Of 3,085 articles screened, 32 were included providing 341 datapoints. Most studies were at low or moderate RoB. Meta-analysis showed a higher risk of mortality from respiratory disease (RR 2·38, [1·18 - 4·80], I2=97%), cardiovascular disease (RR 1·80, [1·32- 2·46], I2=99%), liver disease and cirrhosis (2·50, [1·08-5·77], I2=99%), digestive disease (2·92, [1·09-7·78], I2=99%), neurological disease (1·94, [1·09-3·44], I2=92%), head and neck cancer (RR 21·31, [4·32-105·14], I2=97%), liver cancer (RR 4·07, [2·34-7·08], I2=94%), cervical cancer (3·95, [3·11-5·01], I2=0%), and lung cancer (RR 1·95, [1·34 - 2·85], I2=0%). Morbidity from liver cancer (5·58, [2·02-15·47], I2=78%), lung cancer (RR 1·99, [1·53-2·59], I2=83%), head and neck cancer (1·86, [1·53-2·27], I2=0%), and dementia (HR 2·30, [2·18-2·43], I2=0%) were increased. Patterns of results were similar across studies with differing RoB. Interpretation Incidence of NCDs is substantially higher in people who have experienced imprisonment compared to the general population in high-income countries. This has broad policy and practice implications across Europe, particularly for primary prevention and management of NCDs. Key messages • This review highlights the high burden of NCDs in people who have experienced imprisonment, adding to the evidence base which emphasises the burden of communicable diseases and mental illness. • Investment in policies and interventions to reduce and manage NCDs are required alongside continued management of substance use, mental illness, and communicable diseases in this population.