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  • br INTRODUCTION W orldwide more than million people are


    INTRODUCTION W orldwide, more than 10.3 million people are in prison at any given time,1 and an esti-mated 30 million people move through pris-
    ons annually.2 International and Canadian data reveal that the health of people who experience imprisonment is poor compared with the general LY 379268 across a variety of indicators.3,4 
    From the 1Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada; 2ICES, Toronto, Ontario, Canada; 3Centre for Urban Health Solu-tions, St. Michael’s Hospital, Toronto, Ontario, Canada; and 4Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
    Address correspondence to: Fiona G. Kouyoumdjian, PhD, Depart-ment of Family Medicine, McMaster University, 5th floor, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P1H6, Canada. E-mail: [email protected]
    Primary care access decreases population morbidity and mortality,5 and offers the opportunity for people who experience imprisonment to prevent and manage medical and social problems. Screening for colorectal and breast cancer indicate primary care quality,6 yet there is a lack of data on colorectal and breast cancer screening in this population. Two small studies in Cali-fornia and Rhode Island using self-reported data found that a large proportion of people in prison were not up to date on colorectal and breast cancer screening, with 31% up to date for colorectal7 and 41%7 and 58%,8 respectively, up to date for breast cancer screening. In the California study, many participants lacked knowl-edge regarding colorectal and breast cancer screening,7 although most indicated that they would be willing to access cancer screening in prison.7 This suggests that the time in prison may represent an opportunity for health promotion and screening, including through primary care services.
    The study objectives were to examine the proportion of people released from provincial correctional facilities in Ontario in 2010 who were overdue for colorectal or breast cancer screening at the time of admission, to determine the proportion who were still overdue after 3 years, and to compare these proportions with the gen-eral population. In addition, primary care use was explored in the years before and after admission to pro-vincial correctional facilities.
    This retrospective cohort study compared data on people released from provincial correctional facilities in Ontario, Canada in 2010 with the general population in Ontario, Canada.
    Provincial correctional facilities in Canada house people who are admitted prior to sentencing or sentenced to <2 years; people sentenced to ≥2 years are transferred to federal prison.9 The term provincial correctional facilities is used to represent all provincial facilities, including jails, detention centers, and correctional centers.
    The Ontario Health Insurance Plan (OHIP), the public health insurance plan, pays for healthcare services including primary care and colorectal and breast cancer screening tests for Ontario residents.10 OHIP covers health care in provincial correctional facilities and in the community.
    People in provincial correctional facilities access primary care for an initial assessment within weeks of admission or sooner if medically indicated, and subsequently access care based on identi-fied need for ongoing or episodic care. No systematic program exists in provincial correctional facilities for colorectal or breast cancer screening.
    Study Sample
    For a separate study, the Ontario Ministry of Community Safety and Correctional Services provided identifying data on all adults 
    released in 2010 from provincial correctional facilities, including name, date of birth, sex, self-reported race, OHIP number, and dates of admission and release and reasons for release between 2005 and 2015 (to distinguish periods in custody and in the com-munity). They transferred these data to ICES, an independent, non-profit organization funded LY 379268 by the Ontario Ministry of Health and Long-Term Care, which houses health administrative data for Ontario residents.
    As described previously,11 ICES staff used a validated strategy12 to link people to a unique encoded OHIP number (ICES Key Number) which exists for people who are OHIP-eligible and is used across ICES databases. Linkage was direct using OHIP num-ber if available and valid, or else deterministic or probabilistic using name, sex, and date of birth. The project team excluded linkages that seemed to be incorrect (Appendix Figure 1), and people with a release period of <1 day in 2010, on the assumption that these releases represented administrative status changes.
    To identify individuals in the general population, the project team accessed data for all people who were OHIP-eligible on July 1, 2010 in the ICES registry of OHIP-eligible individuals, exclud-ing people in the corrections group.