Background: Over 100 million Americans have a history of criminal legal involvement (CLI), which is increasingly recognized as a risk for poor disease outcomes. Women with diabetes and CLI may have unique needs and utilization patterns, but this population has not been studied.

Methods: Using nationally representative data, we examined a sample of respondents with lifetime CLI and self-reported diabetes. We compared rates by gender of physical conditions, mental health conditions, and substance use disorders using multivariate logistic regression considering relevant sociodemographic confounders. We then estimated the adjusted odds of outpatient, emergency department and inpatient hospitalization using similar models. Stata 16.1 was used.

Results: In our sample of US adults with diabetes and CLI (N=2,742), 28% were women. Women were generally of lower socioeconomic status but more likely to have insurance. Compared to men, women reported higher rates of comorbid physical conditions, including having ≥2 conditions (aOR 1.5, 95% CI 1.2-1.9); higher rates of serious mental illness (aOR 2.5, 95% CI 1.8-3.6), any mental illness (aOR 2.1, 95% CI 1.6-2.6), and past year major depression (aOR 2.1, 95% CI 1.6-2.8). They were less likely to have a substance use disorder (aOR 0.7, 95% CI 0.5-0.9). Compared to men, women were more likely to use the emergency department (aOR 1.2, 95% CI 1.1-1.3) with a trend towards increased hospitalizations (aOR 1.2, 95% CI 0.9-1.5). They were also more likely to use outpatient care (aOR 2.1, 95% CI 1.3-3.5).

Conclusions: Women with diabetes and CLI have higher rates of chronic disease and mental illness, but lower rates of substance use disorders, a pattern which is distinct. Additional research should consider if addressing the unique needs of this marginalized population could improve diabetes outcomes and decrease unnecessary acute care utilization.


L.Hawks: None. R.J.Walker: None. L.E.Egede: None.


National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK132505-01A1)

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