during that year (NCCHC, 2002). More than 130,000 inmates tested positive for latent TB infection in 1997. An estimated 566,000 inmates with latent TB infection were released in 1996. More recent data (MacNeil et al., 2005) indicate that TB rates remain higher in prison systems than in the general population, and that prisoners with TB are less likely than noninmates to complete treatment. From 1993 to 2003, the percentage of TB cases among local jail inmates increased from 42.8 percent to 53.5 percent. Cases among federal inmates increased from 2.9 percent to 11.8 percent. Inmates with TB were more likely to be coinfected with HIV than noninmates with TB. Outbreaks of multidrug-resistant TB related to HIV coinfection have been documented in correctional facilities. The authors note: “Correctional systems, especially jails, offer distinct logistical obstacles to screening and treatment; inmates are moved frequently or are released, making evaluation and completion of therapy difficult at best.”

Chronic diseases The National Commission on Correctional Health Care report (NCCHC, 2002) provided 1995 prevalence estimates for certain chronic diseases among federal, state, and local inmates: Asthma was estimated at 8 to 9 percent, diabetes at 5 percent, and hypertension at 18 percent. Figures on federal prisoners alone (BJS, 2001b) are somewhat lower: asthma at about 4 percent, diabetes at 4 percent, and hypertension at 8 percent. BJS (2001b) noted that inmate self-reported data may underestimate the prevalence of some medical conditions, especially those problems that require more sophisticated diagnosis and those that are more sensitive in nature. For many conditions, inmate self-reports are the only source of information.

Most state prison systems lack comprehensive and accessible data on the health status of their prisoners. A 1998 inventory of state and federal correctional information systems found that 20 states had electronic information systems that could identify offenders with physical disabilities at admission, 22 had systems that could identify inmates with mental or emotional problems, and 22 could identify inmates with specialized medical conditions. Eighteen states had this information electronically on current medical conditions for more than 75 percent of their inmates (BJS, 1998c).

Mental illness “Prisons are the largest mental health institutions in our country,” stated Darrel A. Reiger, M.D., M.P.H., deputy medical director of the American Psychiatric Association, in his October 19, 2005, remarks to the committee. More than a quarter-million mentally ill individuals were incarcerated in a prison or jail at midyear 1998 (BJS, 1999a). In 1998, more than 179,000 offenders in state prisons, 7,900 in federal prisons, 96,700 in local jails, and almost 548,000 probationers were identified as mentally ill (Table 2-9). In this BJS survey, prisoners were counted as mentally ill if they

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