Inflammation Mediates the Effects of Incarceration on Chronic Health Conditions: Results from a Nationally Representative Sample of Older Adults.

PURPOSE: The U.S. leads the world in incarceration, and individuals with incarceration histories have poorer health outcomes. Inflammation has been proposed as a mechanism linking incarceration and chronic disease, but empirical evidence remains limited. This study tested whether inflammation mediates the association between incarceration and chronic health conditions.

MATERIALS AND METHODS: Data were drawn from the Health and Retirement Study (HRS). Incarceration history was assessed via self-report of spending ≥3 consecutive days in jail or prison. Inflammation was measured using C-reactive protein (CRP). Chronic health conditions were assessed as both an index of six diagnoses (heart disease, hypertension, lung disease, diabetes, cancer, stroke) and individual conditions. Regression-based mediation models with bootstrapping were used to examine indirect effects of incarceration through CRP, adjusting for demographic and health behavior covariates. Analyses accounted for the HRS complex survey design.

RESULTS: Participant history of incarceration associated with higher CRP and higher CRP associated with more chronic conditions. Bootstrapping confirmed significant mediation. Further testing indicated that cancer, stroke, and lung disease may be main drivers of this effect.

DISCUSSION: Findings suggest incarceration associates with chronic disease risk partly through elevated inflammation. While direct effects between incarceration and specific health conditions were inconsistent, the association between incarceration and CRP highlights inflammation as a plausible indirect pathway.

CONCLUSION: Incarceration may increase the risk for multiple chronic health conditions by elevating inflammation, particularly the risk of cancer, stroke, and lung disease. Addressing carceral healthcare quality and strengthening community supports are critical roles for health professionals and social workers.