History of incarceration and oral health among older adults with diabetes: a population-based study of tooth loss and dental care.

PURPOSE: This study aims to examine associations between history of incarceration (HOI) and two oral health outcomes (tooth loss and dental care utilization) among older adults with diabetes, as well as identify factors that may mediate these associations.

DESIGN/METHODOLOGY/APPROACH: The authors used self-report data from the 2012 and 2014 waves of the Health and Retirement Study (a population-based study of adults aged >50 in the USA) to evaluate associations between HOI and the two oral health outcomes, controlling for demographics.

FINDINGS: HOI was associated with greater odds of permanent tooth loss (OR = 1.43, 95% CI = 1.08-1.90) and reduced odds of dental care utilization in the past two years (OR = 0.70, 95% CI = 0.53-0.92). After adjusting for social support and perceived provider mistrust, the association remained but was attenuated (direct effect = -0.310, p = 0.030). Further, 11% of the total effect was explained by the mediators, with social support accounting for 74% of the indirect effect, and perceived provider mistrust accounting for the remaining 26%.

RESEARCH LIMITATIONS/IMPLICATIONS: Findings are limited by the study design. This cross-sectional study had data that was collected at one point in time. Thus, long-term follow-up could not occur. Additionally, the HRS does not differentiate between prison and jail, and health disparities tend to differ between jail and prison. Evidence from this study was preliminary and correlational, and longitudinal work should be conducted.

PRACTICAL IMPLICATIONS: There are disparities in oral health indicators among those with diabetes based on HOI. Future research should identify barriers to oral health diabetes management in prison and test potential interventions to improve diabetes management following release from prison.

ORIGINALITY/VALUE: To the best of the authors' knowledge, this study is the first to provide evidence of oral health disparities among older adults with diabetes with a history of incarceration. No study has yet investigated these important health markers in individuals with a history of incarceration. This is important for future intervention to improve healthcare in the justice system.