Background The adverse health effects of incarceration are well-documented, affecting individuals throughout their life course. However, the influence of a history of incarceration on end-of-life (EOL) experiences remains unexplored. This study aims to examine how prior incarceration affects individuals’ experiences and care needs as they approach the EOL. Methods Leveraging the Health and Retirement Study, we conducted secondary analyses on 1 710 individuals who participated between 2012 and 2018. Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden. Results Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported “moderate” or “severe” pain) compared to nonincarcerated individuals (50%; adjusted odds ratio = 1.45, 95% confidence interval [CI]: 1.22–1.71, p < .001). Additionally, the symptom burden index revealed that formerly incarcerated individuals had a higher average symptom score (2.8 vs 2.1; β = 0.7, 95% CI: 0.5–0.9, p < .001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables. Conclusions This study reveals that a history of incarceration significantly affects EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to nonincarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.

中文翻译：

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2 次经历的故事：有监禁史的临终关怀


背景 监禁对健康的不利影响是有据可查的，会影响个人的整个生命历程。然而，监禁史对临终 （EOL） 经历的影响仍未得到探索。本研究旨在检查先前的监禁如何影响个人在接近 EOL 时的经历和护理需求。方法 利用健康与退休研究，我们对 2012 年至 2018 年间参与的 1 710 人进行了二次分析。通过回顾性队列分析，我们探讨了监禁史与 EOL 护理之间的关联，重点关注疼痛和症状负担。结果分析显示，与未被监禁的人 （50%;调整比值比 = 1.45,95% 置信区间 [CI]：1.22-1.71，p < .001）相比，有监禁史的个体经历的疼痛程度明显更高（65% 报告“中度”或“重度”疼痛）。此外，症状负担指数显示，有监禁史的个体平均症状评分较高（2.8 vs 2.1;β = 0.7,95% CI：0.5-0.9，p < .001），表明他们生命最后一年的症状范围更大。在调整了人口、健康和社会经济变量后，这些差异仍然存在。结论 本研究显示，监禁史会显着影响 EOL 经历，与未监禁的人相比，以前被监禁的人面临更高水平的痛苦和更大的症状负担。这凸显了量身定制的姑息治疗的必要性，以满足这一弱势群体的独特需求。 这项研究强调了干预的关键领域，并呼吁医疗保健系统调整其实践以更好地为有监禁史的人服务。