Association between traumatic brain injury and prison charges: a population-based cohort study

ABSTRACT

Background

Traumatic Brain Injury (TBI) is a serious hidden health issue disproportionately affecting people who experience incarceration.

Objective

We examined the association between TBI and serious disciplinary charges among men and women sentenced by the courts to terms of two or more years.

Methods

The study originated in Ontario, Canada and used linked administrative health and correctional data. The cohort included adults experiencing their first federal sentence between 1998 and 2011 (N = 12,038). We examined disciplinary charges incurred 2 years post-sentence commencement. TBI was defined using the International Classification of Diseases (ICD-9 and ICD-10) diagnostic codes. Robust Poisson regression was conducted to assess the association between TBI and disciplinary charges.

Findings

The prevalence of TBI for the full sample was 13.2%. One-third of adults with a recent TBI had a serious disciplinary charge. The unadjusted risk of incurring a serious charge for those with a history of TBI was 39% higher than those with no history of TBI (CI: 1.29–1.49). The adjusted risk was 1.14 (CI: 1.06–1.22).

Conclusions

TBI is a serious health concern that makes it difficult for incarcerants to adjust to prison. Additional support/resources are needed to support those with histories of TBI.

KEYWORDS:

• Serious charges
• prison
• longitudinal
• data linkage
• sex differences

Acknowledgments

The authors thank Alejandro Gonzalez for his methodological support and expertise and David Kryszajtys and Guido Tacchini for early work on the literature review and methods. The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). This study was also funded by the Social Sciences and Humanities Research Council of Canada (no. 890-2011-0027). Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The study was also supported by MAP Center for Urban Health Solutions, St. Michael’s Hospital, and Dalla Lana School of Public Health, University of Toronto, Ontario.

Declaration of Interest

Leslie Anne Keown, Lynn A. Stewart, and Geoff Wilton are employees of Correctional Service Canada.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). This study was also funded by the Social Sciences and Humanities Research Council of Canada [no. 890-2011-0027]. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The study was also supported by MAP Center for Urban Health Solutions, St. Michael’s Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.