Racial disparities in traumatic injuries sustained in prison: A multicenter retrospective cohort study.

BACKGROUND: Incarcerated individuals experience elevated injury rates, yet data on their injuries-particularly by race-are limited. This study aimed to describe racial differences in the occurrence, characteristics, and outcomes of traumatic prison injuries.

METHODS: This retrospective cohort study included adult trauma patients admitted to five Level I trauma centers (01/2016-07/2022). Patients were categorized as non-Hispanic (NH-) White, Black, or Hispanic. The primary outcome was the proportion of prison injuries among all traumatic injuries. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) admission, and discharge disposition.

RESULTS: Among 53,872 trauma admissions, 187 (0.35%) occurred in prison. Black (0.8%) and Hispanic (0.4%) patients had a higher proportion of prison injuries than NH-White patients (0.3%) (p < 0.0001). After adjustment, Black [OR:2.34 (1.50-3.67)] and Hispanic patients [OR:1.44 (1.02-2.03)] had higher odds of sustaining prison injuries than NH-White patients. There was a trend towards Black patients suffering assaults more than Hispanic or NH-White patients (p = 0.06). NH-White patients (19.3%) sustained self-harm injuries significantly more than Black patients (0%), with no difference compared to Hispanic patients (10%). ICU admission was similar by race. Differences were observed in LOS and discharge disposition, Hispanic patients had the longest stays.

CONCLUSIONS: Black and Hispanic patients had higher odds of having a prison injury than NH-White patients. NH-White patients suffered self-harm more than Black patients, whose most common cause of injury was assault. Differences in injury and discharge patterns suggest potential structural inequities in prisons and discharge practices.