The Hidden Toll of Incarceration: Exploring the Link Between Incarceration Histories and Pain Among Older Adults in the United States

Yulin Yang; Gabriel Lutz; Yilin Zhang; Chixiang Chen; Raya Elfadel Kheirbek

doi:10.1093/geroni/igad116

The Hidden Toll of Incarceration: Exploring the Link Between Incarceration Histories and Pain Among Older Adults in the United States

Innov Aging. 2023 Oct 6;7(10):igad116. doi: 10.1093/geroni/igad116. eCollection 2023.

Authors

Yulin Yang¹, Gabriel Lutz², Yilin Zhang³, Chixiang Chen⁴, Raya Elfadel Kheirbek²

Affiliations

¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
² Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
³ Department of Mathematics, University of Maryland, College Park, Maryland, USA.
⁴ Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Abstract

Background and objectives: Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study examines the relationships between incarceration histories and pain outcomes among middle-aged and older adults in the United States.

Research design and methods: Data from a nationally representative sample of community-dwelling adults aged 51 and over in the 2012-2018 biennial waves of the U.S. Health and Retirement Study was analyzed to examine how incarceration histories influence older adults' risks of reporting moderate-to-severe pain and pain with physical limitations. We relied on a propensity score matching approach to account for the potential confounding bias. We fit weighted generalized estimating equation models to assess the relationships between incarceration history and pain outcomes. Models were further stratified by gender.

Results: After propensity score matching, our sample included 2,516 respondents aged 65 years on average (SD = 8.72), 21% female, and 838 with incarceration histories. Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (prevalence ratio [PR] = 1.30, 95% confidence Interval [CI]: 1.20, 1.52) and pain with physical limitations (PR = 1.48, 95% CI: 1.30, 1.68) even after adjusting for sociodemographic covariates and early life experiences. In the models stratified by gender, the associations between incarceration histories and incarceration were similar among women and men.

Discussion and implications: In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal management strategies to reduce the burden of disabling pain. Interventions should prioritize socioeconomically vulnerable groups who may have the least access to pain treatment in later life.

Keywords: Incarceration; Pain; Palliative care.

Abstract

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