End-Stage Liver Disease in a State Prison Population

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End-Stage Liver Disease in a State Prison Population

Jacques Baillargeon PhD, a, , D. Soloway MDa, Paar MDa, P. Giordano MD, MPHa, Owen Murray DOa, Grady DrPHa, Brie MDa, Pulvino PAa and Ben G. Raimer MDa aFrom the Department of Preventive Medicine and Community Health (J.B., D.P., J.P., O.M., B.G.R) and the Department of Medicine (R.D.S.), and Community Health Services (J.B., D.P., P.M., J.P., B.G.R.), University of Texas Medical Branch, Galveston; the Department of Medicine, Baylor College of Medicine, Houston, TX (T.P.G.); and the Department of Medicine, University of California at San Francisco, San Francisco (B.W.) Objectives

Information on the epidemiology of end-stage liver disease (ESLD) in US correctional populations is limited. We examined the prevalence, mortality and clinical characteristics of ESLD in the nation's second largest state prison system. Methods We collected and analyzed medical and demographic data from 370,511 offenders incarcerated in Texas' prison system during a 3.5-year period. Results ESLD was diagnosed in 484 inmates (131/100,000); 213 (57/100,000) died of ESLD. Offenders who were Hispanic, 30–49 years of age, ≥50 years of age, HIV monoinfected, hepatitis C virus (HCV) monoinfected, or HIV/HCV coinfected had elevated ESLD prevalence and mortality rates. Conclusions ESLD mortality in Texas' prison population is approximately 3 times higher than that of the general population, reflecting elevated rates of HCV and HIV/HCV coinfection among prisoners. Ultimately, the only viable treatment option for many prisoners with ESLD will be liver transplantation. The enormous costs of organ transplantation and immunosuppressive therapy are staggering and have the potential to decimate the healthcare budgets of most prison systems. Consequently, it is imperative that correctional healthcare programs expand HCV treatment and prevention strategies. Key Words: End-Stage Liver Disease; Hepatitis C; HIV; Prisons Abbreviations: ESLD, end-stage liver disease; HCV, hepatitis C virus; MELD, model for end-stage liver disease; TDCJ, Texas Department of Criminal Justice

Address correspondence and reprint requests to: Dr. Jacques Baillargeon, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston TX 77555.

ls of Epidemiology Volume 17, Issue 10, October 2007, Pages 808-813