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Abstract
Introduction Half of all deaths in custody are due to natural causes, the most common being cardiovascular disease (CVD). National Health Service Healthchecks should be available to all eligible prisoners; it is not clear who receives them. Mental health issues are common in prisoners and may affect how healthcare interventions should be delivered. Current policy is to offer Healthchecks to those serving over 2 years in prison.
Objectives, methods, setting and design An observational cross-sectional survey in six male prisons in England between September 2017 and January 2019 in prisoners aged 35–74 to identify who was eligible for a Healthcheck and compare CVD risk data with those that were not, and factors associated with uptake.
Outcome measures Characteristics of those accepting a Healthcheck were compared with those declining. Assessments of anxiety and depression were compared with CVD risk factors.
Results 1207 prisoners completed a Healthcheck. 21.8% of prisoners were ineligible due to existing comorbidities. 76.4% of those invited took up a Healthcheck, and of those, 12.1% were found to have new significant CVD comorbidity. CVD risk was similar to community levels but this population was 10 years younger. Definite case-level depression or anxiety was present in 20.7% and 18.0%, respectively, of participants. An association was found between ethnicity and those invited (p=0.023, φ=0.1) and accepting (p=0.008, φ=0.1) a Healthcheck. 9.7% of prisoners serving less than 2 years had CVD risk scores of 10% or more, and had similar CVD risk profiles but much higher levels of anxiety (p<0.001, φ=0.2) or depression (p=0.009, φ=0.2) than those serving 2 years or more.
Conclusion Cardiovascular risk was comparable with community rates and in some prisons, much higher. Rates of anxiety and depression were high. The national policy for selecting prisoners for Healthchecks may leave many high-risk prisoners without appropriate cardiovascular preventative assessments.
- healthchecks
- prisoners
- mental health
- cardiovascular medicine
- organisation of health services
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Footnotes
Contributors CP designed the study, wrote the proposal and led the research. MW initiated the data collection, trained healthcare staff, liaisied with the Ethics committee, and led the qualitative research. EB led the research teams collecting the data, completed the project management required by CLARHC, and developed the methods section. JM undertook the statistical analysis and commented on presentation. RM developed the PHQ-9 and GAD-7 analysis. KK helped wih refinements to the study design based on past community research. RM and KK commented extensively on the manuscript. All authors contributed individually to the report content.
Funding The study was funded by Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and acknowledges the support of the National Institute for Health Research Clinical Research Network (NIHR CRN), Nottinghamshire Healthcare NHS Foundation Trust Research Deliver Team, Lincolnshire Partnership Foundation Trust Research Delivery Team and the Governors and the six Offender Healthcare Services involved in the research project from HMPs Gartree, Lincoln, Lowdham, Nottingham, Ranby and Whatton.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained from North-East York Research Ethics Committee (16/NE/0133) and the NHS England Health Research Authority (HRA). Her Majesty’s Prison and Probation Service approval was obtained and individual prison governors’ permissions obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. Anonymised data are currently held securely in the host NHS Trust and Leicester University as per the research protocol.