摘要：Objectives. We investigated whether there were gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates and whether substance dependence mediated any gender differences found. Methods. We analyzed data from a nationally representative survey of 6982 US jail inmates. Weighted estimates of disease prevalence were calculated by gender for chronic medical disorders (cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis), psychiatric disorders (depressive, bipolar, psychotic, posttraumatic stress, anxiety, and personality), and substance-dependence disorders. We conducted logistic regression to examine the relationship between gender and these disorders. Results. Compared with men, women had a significantly higher prevalence of all medical and psychiatric conditions ( P ≤ .01 for each) and drug dependence ( P < .001), but women had a lower prevalence of alcohol dependence ( P < .001). Gender differences persisted after adjustment for sociodemographic factors and substance dependence. Conclusions. Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, psychiatric, and drug-treatment needs of women at risk for incarceration, both in jail and after release. Approximately 13 million individuals spent time in a US jail facility during 2007. 1 At midyear, 780 581 individuals were held in a jail. 1 Jails are facilities, generally operated by local city or county governments, that hold individuals before trial or sentencing (adjudication) or individuals serving short sentences. 2 Despite the explosive growth of the criminal-justice population over the last 30 years, 3 the exclusion of inmates from most national health surveys has made it difficult to systematically study the broad range of health conditions that inmates face. Estimates of disease prevalence among inmates in the United States have generally had to rely on data from individual cities or states, 4 use extrapolations from the general, noninstitutionalized population, 5 or focus on infectious diseases. 6 – 8 Even less epidemiological information is available about the health problems of female inmates and gender differences among jail inmates. In the noninstitutionalized, general population, women report worse physical health and a higher prevalence than men of some mental-health disorders, such as depression and anxiety. 9 Among jail inmates in the United States, a higher proportion of women (53%) than men (35%) report a current medical problem. 10 In correctional facilities in New South Wales, Australia, a survey of inmates found that 81% of women and 65% of men had at least 1 chronic health condition. 11 In a nonrandom sample of individuals being released from a New York City jail, women reported a higher prevalence of depression, anxiety, and asthma than men, and women were more likely to have visited an emergency room or have had a hospital admission than men. 12 However, gender differences reported in these previous studies did not account for age, race, and education as possible confounders. Many women in jail have a history of sexual and physical abuse, 13 psychiatric disorders, 14 , 15 psychological distress, 16 , 17 and substance dependence, 18 , 19 conditions that can complicate the recognition of and provision of medical care for other chronic medical conditions. For instance, drug dependence can complicate the management of chronic medical conditions in the community (e.g., hypertension) because of competing needs for drug treatment, housing, employment, and income, and because of mistrust between drug users and medical providers. Drug and alcohol dependence, common in jail inmates, 18 also causes health problems, either directly via the toxic effects of the substance (e.g., overdose, alcoholic hepatitis) or indirectly via use practices (e.g., sharing syringes, which can cause blood-borne infections). Therefore, in jail inmates, substance dependence should be considered when assessing gender differences in other chronic medical and psychiatric conditions. The complexity of conducting large surveys in correctional settings and the exclusion of inmates from other major health surveys in the United States (e.g., the National Health Interview Survey) have made national-level comparisons of male and female inmates difficult. To understand and meet the needs of women who interact with the criminal justice system, there is a need for greater knowledge about the relationship between gender and the chronic health characteristics of jail inmates. Management of the wide range of chronic conditions among inmates is particularly important in light of inmates' increased risk of death after release from incarceration. 20 – 30 Although many deaths are related to drug use and suicide, there is also an excess risk of death related to cardiovascular disease, liver disease, and other diseases. We examined whether there were gender differences in chronic medical conditions, psychiatric disorders, and drug and alcohol dependence among jail inmates at a national level. Our first aim was to determine whether the prevalence of chronic medical conditions, psychiatric disorders, and drug and alcohol dependence differed between male and female jail inmates after differences in demographic and socioeconomic factors were accounted for. Our second aim was to determine whether gender differences in chronic medical conditions and psychiatric disorders persisted after adjusting for differences in drug and alcohol dependence. Our hypothesis was that female inmates would have a higher prevalence of chronic medical disorders, psychiatric disorders, and substance-dependence disorders than male inmates, even after other demographic and socioeconomic factors had been adjusted for. We further hypothesized that substance dependence would attenuate the differences in medical and psychiatric conditions between men and women in jail.
