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T. M. McMillan, L. Graham, J. P. Pell, A. McConnachie, D. F. Mackay (2019)


There is mounting evidence that associates brain injury and offending behaviour, and there
is a need to understand the epidemiology of head injury in prisoners in order to plan interventions
to reduce associated disability and risk of reoffending. This is the first study to determine
the lifetime prevalence of hospitalised head injury (HHI) in a national population of
current prison inmates. In addition characteristics of prisoners with HHI and were compared
to prisoners without HHI to discover whether those with HI differed demographically.

Whole life hospital records of everyone aged 35 years or younger and resident in a prison in
Scotland on a census date in 2015 were electronically linked via their unique NHS identifier
and checked for ICD-9 and 10 codes for head injury. Using a case-control design, these
data were compared with a sample from the general population matched 3:1 for age, gender
and area-based social deprivation. Comparison of demographic variables was made
between prisoners with and without HHI.

HHI was found in 24.7% (1,080/4,374) of prisoners and was significantly more prevalent
than found in the matched general population sample (18.2%; 2394/13122; OR 2.10; 95%CI
1.87, 2.16). The prevalence of HHI in prisoners and controls was similar with the exception
of a higher risk of HHI in prisoners in lower deprivation quintiles. Having three or more HHI
was more common in prisoners (OR 3.04; 95%CI 2.33, 3.97) as were HHI with ICD codes
for intracranial injuries (OR 1.81; 95% CI 1.54, 2.11), suggesting that more severe HHI is
more prevalent in prisoners than the general population. The distributions within demographic
variables and the characteristics of HHI admissions in prisoners with and without a
history of HHI were similar.

Prisoners in Scotland aged 35 years or younger have a higher lifetime prevalence of HHI
than the general population and are more likely to have had repeated HI or intracranial injuries. Further work is required to elucidate the correspondence between self-report of HI and hospitalised records and to ascertain persisting effects of HI in prisoners and the need for services to reduce associated disability and risk of reoffending.


The full paper can be found here