Incidence of physical non-communicable disease in people who have experienced imprisonment compared with the general population in high-income countries: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals suggest statistical significance for most outcomes

• Effect Size: Risk ratios ranging from 1.80 (cardiovascular disease) to 21.31 (head and neck cancer)

• Primary Outcome: NCD mortality and morbidity risk ratios comparing formerly incarcerated to general population

• Nnt Or Sensitivity: Number needed to harm varies by condition; absolute risk differences not calculable from available data

• Confidence Interval: Most outcomes showed statistically significant elevated risks with non-overlapping confidence intervals

Clinical Application

Findings support enhanced screening and prevention programs for formerly incarcerated populations, though implementation requires healthcare system coordination Relevant to Australian correctional health policy and post-release healthcare planning. May inform PBS access considerations and RACGP guidelines for high-risk populations Formerly incarcerated individuals in high-income healthcare systems including Australia

Abstract

BACKGROUND: Non-communicable diseases (NCDs) represent a significant cause of morbidity and mortality globally. Despite a strong evidence base outlining increased risk of communicable diseases and poor mental health in people who have experienced imprisonment, the risk of NCDs has not been quantified in previous reviews. This study aimed to describe the incidence of morbidity and mortality of physical NCDs in people who have experienced imprisonment compared with the general population in high-income countries. METHODS: We searched MEDLINE, Embase, CINAHL and SocINDEX (PROSPERO CRD42024540173) for comparative studies of morbidity or mortality from NCDs. Articles were assessed against predefined criteria to select studies that included people with experience of imprisonment; measured NCD incidence; compared incidence to a general population; and were conducted in a high-income country. Two reviewers conducted independent risk of bias assessment using an adapted version of the Newcastle-Ottawa Scale. Data were synthesised using random-effects meta-analyses and vote counting based on effect direction. Meta-regression and subgroup analysis investigated heterogeneity. RESULTS: Of 3085 articles screened, 32 were included providing 341 datapoints. Meta-analysis showed a higher risk of mortality from several diseases, including respiratory disease (risk ratio (RR) 2.38 (95% CI 1.18 to 4.80), I2=97%), cardiovascular disease (RR 1.80 (95% CI 1.32 to 2.46), I2=99%), liver disease and cirrhosis (RR 2.50 (95% CI 1.08 to 5.77), I2=99%), digestive disease (RR 2.92 (95% CI 1.09 to 7.78), I2=99%), neurological disease (RR 1.94 (95% CI 1.09 to 3.44), I2=92%), head and neck cancer (RR 21.31 (95% CI 4.32 to 105.14), I2=97%), liver cancer (RR 4.07 (95% CI 2.34 to 7.08), I2=94%), cervical cancer (RR 3.95 (95% CI 3.11 to 5.01), I2=0%) and lung cancer (RR 1.95 (95% CI 1.34 to 2.85), I2=0%). Synthesis without meta-analysis also indicated imprisonment was associated with increased morbidity from multiple NCDs. CONCLUSIONS: Several NCDs, including multiple cancers, cardiovascular disease, respiratory disease and liver disease, are substantially more common in people who have experienced imprisonment compared with the general population, highlighting a need for primary prevention and NCD management.

References

1. 1.Dorrans, B., Tindall, M., Thomson, R. M., Mackinnon, S., Broadbent, P., Wells, V., Williamson, A. E., & Katikireddi, S. V. (2026). Incidence of physical non-communicable disease in people who have experienced imprisonment compared with the general population in high-income countries: a systematic review and meta-analysis. Journal of Epidemiology and Community Health. https://doi.org/10.1136/jech-2025-225296