||5R01CA230444-02 Interpret this number
||Incarceration and Cancer-Related Outcomes (ICRO)
The United States has the largest number of individuals incarcerated in the world, the majority of whom are of
racial and ethnic minority groups and lower socioeconomic status. Thehigh incarceration rate of minority and
poorindividuals makes it especially important tounderstand the epidemiology of cancer among individuals with
a history of incarceration and the impact of incarceration on cancer disparities. Individuals with a history of
incarceration have higher rates of cancer risk factors, and some work has suggested that incarceration history
is associated with a higher risk of cancer mortality. However, prior work has not examined the impact of mass
incarceration on access to high quality cancer care, or the degree to which incarceration might contribute to
cancer disparities. Until this knowledge gap is addressed, we will not be able to identify effective and durable
interventions to mitigate observed disparities in cancer morbidity and mortality. The long-term goal of this
application is to reduce disparities in cancer outcomes. The overall objective, which is a next step toward
achieving this long-term goal, is to assess the impact of incarceration on cancer outcomes and disparities in
cancer detection, quality of treatment, and survival. The central hypothesis of Incarceration and Cancer-
Related Outcomes (ICRO) study is that incarceration contributes to racial and socioeconomic disparities in
cancer detection, quality of treatment, and mortality. The underlying rationale for this proposed study is that
there are currently no ongoing or past cancer epidemiologic studies that enable us to measure the contribution
of incarceration on observed racial and socioeconomic disparities. To address this knowledge gap, we will
create the first comprehensive linkage of a tumor registry, correctional system data, and state vital statistics
supplemented with in-depth interviews, to conduct a sequential explanatory mixed methods study of individuals
with cancer. We will describe the burden of cancer among individuals with a history of incarceration at the
population level in Connecticut (Aim 1). And among Connecticut residents who are diagnosed with cancer
(2005-2014), we will assess the relation between incarceration and cancer mortality; the quality of cancer care;
and the degree to which incarceration status moderates the relation between race, socioeconomic status and
quality of cancer care and mortality (Aim 2-4). We will then use these data to inform a qualitative study of
individual perceptions regarding accessing cancer care in the correctional system and in the immediate post-
release period (Aim 5). ICRO will be the first study to shed light on a population level how incarceration may be
a substantive contributor to racial and socioeconomic cancer disparities. This study is highly innovative in its
application of a mixed methods approach and construction of a novel data linkage to address the important yet
understudied question of the contribution of incarceration on observed racial and socioeconomic cancer
disparities. Together, the knowledge produced will have a positive impact, as it will result in potential targets for
interventions to improve cancer outcomes among the millions of individuals with a history of incarceration.
Cancer Prevalence Among Adults with Criminal Justice Involvement from a National Survey.
, Winkelman T.N.A.
, Gross C.P.
, Wang E.A.
Journal of general internal medicine, 2020 Mar; 35(3), p. 967-968.