The profile of prisoners with tuberculosis in Japan

• DOI: https://doi.org/10.1108/IJPH-03-2017-0013
• Published date: 10 September 2018
• Date: 10 September 2018
• Pages: 153-162
• Author: Lisa Kawatsu,Kazuhiro Uchimura,Makoto Kobayashi,Nobukatsu Ishikawa
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

The profile of prisoners with tuberculosis

in Japan

Lisa Kawatsu, Kazuhiro Uchimura, Makoto Kobayashi and Nobukatsu Ishikawa

Abstract

Purpose –Although globally, prisoners are considered one of the vulnerable groups to tuberculosis (TB), little

is known about the situation of TB in prison setting in Japan. The purpose of this paper is to examine the

characteristics of TB among prisoners in Japan.

Design/methodology/approach –Records of TB patients from one medical prison were analyzed in terms

of general demographic characteristics, clinical manifestations, risk factors and delay in diagnosis and in

initiating treatment, and compared with data from the national TB surveillance and other published data on

health of inmates, where appropriate. Continuous variables were compared using student independent

samples t-test. Proportions were compared using χ

2

or Fisher exact test as appropriate. Kaplan–Meier

survival analysis was conducted to determine the time from entry to prison institution to diagnosis of TB.

Findings –A total of 49 patients were analyzed. The mean age was 49.5 (±14.3) and 69.4 percent were

males. Being unemployed and homeless prior to incarceration, and several co-morbidities were potential risk

factors for TB (po0.01). Analysis of diagnosis and treatment delay showed that 16.1 percent of smear

positive patients took more than a week to be placed on treatment after being diagnosed of TB.

Approximately 50 percent of the patients were diagnosed within four months of entering the prison institution.

Practical implications –Several potential risk factors identified suggest the need to strengthen screening

for specific sub-groups within the prison population, such as those with poor socio-economic status and

co-morbidities, as well as to consider the possible role of systematic screening for latent TB infection.

Originality/value –This study presents some important data to help understand the profile of TB patients in

prisons in Japan, as well as showing that a detailed epidemiological analysis of existing records can provide

useful insight.

Keywords Health in prison, Public health, Correctional health care, Prisoners, Infectious disease,

Tuberculosis

Paper type Research paper

Introduction

Tuberculosis (TB) is a serious health issue in prisons all over the world. Numerous reports have

indicated that the incidence of TB among prisoners can be several times higher than that of the

general population (Angie et al., 2000; Dara et al., 2009). In prisons of low and middle-income

countries, the incidence can be up to 100 times higher than that of the general population, and

TB is also often reported as one of the most common causes of death (Reyes and Coninx, 1997).

In high-income countries too, it has been reported that prisoners are at a higher risk of acquiring

TB infection and developing the disease (Baussano et al., 2010; European Center for Disease

Prevention and Control/WHO, 2012), as well as defaulting from both treatment for active TB

(Fry et al., 2005) and preventive therapy for latent tuberculosis infection (Al-Darraji et al., 2012).

TB in prisons may also spread to the community at large, through prison staff, visitors and

released prisoners (Niveau, 2006). One study has indicated that the transmission dynamics

between the prisoner and the general population may have substantial impact on the overall

population-level of TB incidence, prevalence and mortality rates (Stuckler et al., 2008). Early case

detection via an effective screening policy of prisoners thus has implications not only for prisoners

and prison staff, but also for the general population.

Received 6 March 2017

Revised 31 October 2017

Accepted 16 November 2017

This research was partially funded

by the Research Program on

Emerging and Re-emerging

Infectious Diseases from Japan

Agency for Medical Research and

development, AMED (Ref No.

16fk0108204h0002). The funder

did not play any role in the study

design, implementation and

submission to the journal.

Lisa Kawatsu is Senior

Epidemiologist at The

Research Institute of

Tuberculosis, Japan

Anti-Tuberculosis Association,

Tokyo, Japan.

Kazuhiro Uchimura is based

at The Research Institute

of Tuberculosis, Japan

Anti-Tuberculosis Association,

Tokyo, Japan.

Makoto Kobayashi is based at

Tama Juvenile Training School,

Tokyo, Japan.

Nobukatsu Ishikawa is based

at The Research Institute

of Tuberculosis, Japan

Anti-Tuberculosis Association,

Tokyo, Japan.

DOI 10.1108/IJPH-03-2017-0013 VOL. 14 NO. 3 2018, pp. 153-162, © Emerald Publishing Limited, ISSN 1744-9200

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