By Laura M. Maruschak

and Allen J. Beck, Ph.D.

BJS Statisticians

In 1997 an estimated 347,000 State

and Federal prison inmates reported

having a physical impairment or mental

condition. Thirty-one percent of State

inmates and 23% of Federal inmates

reported having a learning or speech

disability, a hearing or vision problem,

or a mental or physical condition. 

Based on data from personal interviews, an estimated 318,000 State and

Federal inmates reported being injured

since admission. Ten percent of State

inmates and 3% of Federal inmates

reported being injured in a fight. About

1 in 5 State and Federal inmates said

they had been injured in an accident.

Nearly 1 in 6 State inmates reported a

medical problem other than a cold, an

injury, or a problem that had required

surgery since admission. Specific

conditions reported by State inmates

included heart (1.1%), circulatory

problems other than heart (2.4%),

respiratory problems (1.4%), kidney/

liver problems (0.9%), and diabetes

(0.9%). Many of these conditions may

have existed before the inmates’

admission to prison.

The findings in this report are based on

the 1997 Survey of Inmates in State

and Federal Correctional Facilities.

Inmates were asked a series of

questions related to physical impairments and mental conditions that they

had, as well as medical problems that

they had after admission to prison.

(See questions, pages 2, 4, and 7.) 

U.S. Department of Justice

Office of Justice Programs

 Physical 11.9 11.1

 Mental 10.0 4.8

 Vision 8.3 7.6

 Hearing 5.7 5.6

 Speech 3.7 2.2

 Learning 9.9 5.1

Any condition 31.0% 23.4%

State Federal

Percent of inmates

Other 16.7 15.9

Required surgery 7.5 9.6

21.4 21.7

Medical problem

 (exclude injury)

Injured 28.2 26.2

Cold/virus/flu 19.0% 21.9%

State Federal

Reported problem

since admission

Percent of

inmates

72 mo or more 45.9 30.4

48-71 mo 36.8 20.3

24-47 mo 26.7 20.4

12-23 mo 19.8 19.1

Less than 12 mo 13.2% 15.8%

Medical problem

Injured (exclude injury)

Time since

admission

Percent of State inmates

45 or older 39.8 47.6

35-44 25.2 34.0

25-34 17.2 26.8

24 or younger 12.1 % 23.8 %

Age

Female 27.2 34.4

Male 21.0 % 30.7 %

Gender

Physical

impairment

or mental

condition

Medical 

problems

(exclude injury)

Percent of State inmates

• 12% of State inmates and nearly 

6% of Federal inmates reported

having a learning or speech disability. 

• Nearly 12% of State inmates and

11% of Federal inmates reported a

hearing or vision problem.

• 21% of State inmates and 22% 

of Federal inmates said they had a

medical problem (excluding injury)

after admission; 7% and 10%, 

respectively, said they had a 

medical problem that required 

surgery.

• Nearly half of State inmates who had

served 6 or more years said they had

been injured after admission. Fewer

than 20% of those in prison less than

2 years reported an injury.

• 40% of State inmates and 48% 

of Federal inmates age 45 or older

said they had had a medical problem

since admission to prison. This

problem may have reflected medical

conditions existing before admission.

• About a quarter of female inmates

and a fifth of male inmates reported a

medical problem since admission.

Highlights

Medical problems and other conditions more common 

among older inmates

Nearly a third of State inmates and a quarter of Federal inmates

reported having some physical impairment or mental condition

More than 1 in 4 State and Federal inmates had been injured after 

admission to prison

Injuries and other medical problems increase with time in prison

January 2001, NCJ 181644

Medical Problems of Inmates, 1997

Bureau of Justice Statistics

Special Report
State and Federal inmates asked 

to report on physical impairments,

injuries, and other medical problems

During hour-long personal interviews

inmates were asked a series of

questions related to their physical and

mental health. (See box below.) As

part of an omnibus survey conducted

every 5 to 6 years, these questions

provide an opportunity to estimate the

prevalence of a variety of diseases,

illnesses, chronic problems, and other 

health-related conditions of inmates. 

The accuracy of the estimates depends

on the ability and willingness of

inmates to report such problems.

Inmate self-reported data may underestimate the prevalence of some

medical conditions, especially those

problems that require more sophisticated diagnosis and those that are

more sensitive in nature. 

For many conditions, inmate selfreports are the only source of information. Most State prison systems lack

comprehensive and accessible data 

on the health status of their inmates. 

A 1998 inventory of State and Federal

correctional information systems found

that 20 States had electronic information systems that could identify offenders with physical disabilities at time of

admission, 22 had systems that could

identify inmates with mental or

emotional problems, and 22 could

identify inmates with specialized

medical conditions. Eighteen States

had this information electronically on

current medical conditions for more

than 75% of their inmates. (See State

and Federal Corrections Information

Systems, BJS report, NCJ 170016.)

In general, medical records are stored

in paper form, not electronically. In the

1998 inventory, 10 States reported

they did not collect data on the current

medical condition of their inmates, 

18 had the data only in paper form, and

5 had electronic data on less than 75%

of their inmates. Fewer than a third of

State corrections departments maintain

electronic records on the medical treatment of inmates.

In the absence of accessible data on 

the medical problems of inmates, some

researchers have estimated the prevalence rates of targeted medical conditions from surveys of the health status

of the civilian non-institutional populations. For example, a study prepared

for The National Commission on

Correctional Health Care, estimated

the prevalence rates of asthma, diabetes, hypertension, and heart disease 

in State prisons by applying observed

2 Medical Problems of Inmates, 1997

221,198 21.0% 15,821 17.9%

Condition that limits 

ability to work

 Physical 125,257 11.9 9,839 11.1

 Mental 105,536 10.0 4,256 4.8

 Vision 87,242 8.3 6,688 7.6

 Hearing 60,054 5.7 4,921 5.6

 Speech 39,166 3.7 1,956 2.2

 Learning 103,789 9.9 4,477 5.1

 Any 326,256 31.0% 20,734 23.4%

or mental condition Number Percent Number Percent

Physical impairment State inmates Federal inmates

Table 1. Estimated number and percent of State and Federal inmates with a

physical impairment or mental condition, 1997

Items in the 1997 Survey of inmates in State and 

Federal Correctional Facilities include:

Do you have ... 

A physical, mental, or other health condition which 

limits the kind or amount of work you can do?

1 â Yes 2 â No

Difficulty seeing ordinary newsprint, even when 

wearing glasses?

1 â Yes 2 â No

Difficulty hearing a normal conversation, even when 

wearing a hearing aid?

1 â Yes 2 â No

A learning disability, such as dyslexia or attention 

deficit disorder?

1 â Yes 2 â No

A speech disability, such as a lisp or stutter?

1 â Yes 2 â No

A physical disability?

1 â Yes 2 â No

A mental or emotional condition?

1 â Yes 2 â No

These questions were adapted from the National Adult

Literacy Survey (NALS), conducted by the National

Center for Education Statistics in 1992. (See Methodology.) The NALS survey provided prevalence estimates

on both the general population and State and Federal

prison populations. Responses of inmates in the 1997

Survey of Inmates in State and Federal Correctional

Facilities were similar to those in the NALS survey.

 

-- Not reported.

*Includes both State and Federal inmates.

12 14 21

Condition limits

ability to work

Physical 9 9 12

Mental 2 6 10

Vision 7 7 8

Hearing 7 6 6

Speech 1 -- 4

Learning 3% 11% 10%

Prison* Prison*

General

population

or mental 

condition

1997 BJS 

survey

1992 NCES Adult 

Literacy Survey

Physical 

impairment

Percent reporting condition

Key survey items on physical impairments and mental conditions
rates among civilians in the lowest

socioeconomic quartile and adjusting

for the differing age, gender, and 

racial distributions of inmates. (See

Hornung, Greifinger, and Gadre, 

“A Projection Model of the Prevalence

of Selected Chronic Diseases in the

Inmate Population,” in The Health

Status of Soon-to-be Released

Inmates, National Institute of Justice,

forthcoming). Though based on

in-depth major health surveys, physical

examinations, and the results of

laboratory tests, such estimates are

indirect. 

Nearly a third of State inmates and a

quarter of Federal inmates reported

a physical impairment or mental

condition

In response to questions in the 1997

Survey of Inmates in State and Federal

Correctional Facilities, 31% of State

inmates and 23% of Federal inmates

said they had a physical impairment or

mental condition (table 1). About 1 in 5

State and Federal inmates reported

having some condition that limited their

ability to work.

Ten percent of State inmates and 5%

of Federal inmates reported a learning

disability, such as dyslexia or attention

deficit disorder. Among State inmates

4% had a speech disability such as a

lisp or stutter; among Federal inmates,

2%.

About 6% of both State and Federal

inmates reported difficulty hearing 

a normal conversation even when

wearing a hearing aid. Among both

State and Federal prisoners about 8%

had difficulty seeing ordinary newsprint

even when wearing glasses.

Ten percent of State prisoners and 5%

of Federal prisoners reported having 

a mental or emotional condition. More

than 1 in 10 of both State and Federal

inmates reported a physical condition. 

(For a detailed analysis of mental and

emotional conditions, see Mental

Health and Treatment of Inmates and

Probationers, BJS Special Report, 

NCJ 174463.)

Rates of speech and vision impairment higher among inmates than 

in the general population 

A comparison between the prison

population and the general population

can be made on a selected group of

physical impairments including speech

disabilities, hearing impairments and

vision impairments. The comparison 

uses data from Current Estimates from

the National Health Interview Survey,

1996, a report by the National Center

for Health Statistics. 

The prevalence of speech disabilities

among State inmates (3.7%) is more

than 3 times higher than in the general

U.S. population (1.0%). The percentage with impaired vision among

inmates (8.3%) is more than twice as

high as in the overall U.S. population

(3.1%). The percentage with impaired

hearing is lower among inmates (5.7%)

than in the U.S. population (8.3%).

Some of these differences result from

differing age and gender distributions.

For example, a high percentage of

inmates are middle age and male. In

addition, juveniles are included in the

U.S. population figures, while less than

1% of State prisoners are under age

18. For comparison, the effects of

these differences can be taken into

account by standardizing the general

population to resemble the age and

gender distribution of State inmates.

*Age and gender standardized to the State

prison population.

Data source: Current Estimates from the

National Health Interview Survey, 1996, 

the National Center for Health Statistics.

Hearing 8.3 6.6

Vision 3.1 3.5

Speech 1.0% 1.3%

 Percent in the general population 

Actual Standardized*

Physical

impairment

Once standardized, rates of speech

and vision impairments are still higher

among inmates. Overall, an estimated

1.3% of the comparable U.S. population is found to have a speech impairment and 3.5% a vision impairment.

(See Methodology for details on the

standardization procedure.) 

 Medical Problems of Inmates, 1997 3

45 or older 38.6 5.4 2.5 11.5 15.2 21.9 5.9

35-44 22.1 5.5 2.1 5.3 6.5 9.9 5.3

25-34 16.9 4.6 2.0 2.7 4.5 7.3 3.9

24 or younger 13.8% 5.1% 2.7% 2.3% 3.0% 2.1% 4.0%

Age

Female 29.9 5.6 1.4 5.8 8.6 13.9 9.7

Male 22.9% 5.0% 2.3% 5.5% 7.5% 10.9% 4.4%

Gender

Federal prisoners

45 or older 47.6 8.6 4.3 13.4 19.8 25.2 11.7

35-44 34.0 9.7 4.5 6.7 8.8 14.6 12.0

25-34 26.8 9.8 3.1 4.0 5.5 9.0 9.2

24 or younger 23.8% 11.1% 3.3% 2.5% 5.5% 5.0% 7.8%

Age

Female 34.4 8.7 3.3 6.5 8.8 13.5 16.1

Male 30.7% 10.0% 3.7% 5.6% 8.2% 11.8% 9.6%

Gender

State prisoners

Characteristic Any condition Learning Speech Hearing Vision Physical Mental

Percent of inmates who reported a physical impairment or mental condition

Table 2. Physical impairments and mental conditions of State and Federal inmates, by selected characteristics, 1997
Older inmates more likely to report

physical impairments or a mental

condition

Offenders who were age 45 or older

were the most likely to report having a

physical impairment or mental condition (table 2). Forty-eight percent of

State inmates and 39% of Federal

inmates age 45 or older said they had

a physical impairment or mental condition compared to 24% of State prisoners and 14% of Federal prisoners age

24 or younger. 

Among the specific physical impairments, State and Federal inmates age

45 or older were more likely than those

age 44 or younger to report difficulty

hearing, difficulty seeing, and physical

conditions. Among State inmates age

45 or older, 13% reported difficulty

hearing, 20% reported difficulty seeing,

and 25% said they had a physical

condition compared to 3%, 6%, and

5% of those age 24 or younger.

Among Federal inmates age 45 or

older, 12% said they had difficulty

hearing, 15% had difficulty seeing, and

22% reported a physical condition.

Among those age 24 or younger, 2%

said they had difficulty hearing, 3% had

difficulty seeing, and 2% reported a

physical condition.

The prevalence of physical impairments and mental conditions also

varied by gender. Female inmates in

both State and Federal prisons more

commonly reported having a physical

impairment or mental condition. Thirtyfour percent of female State inmates

and 30% of female Federal inmates

reported having any condition

compared to 31% of male State

inmates and 23% of male Federal

inmates.

More than 1 in 10 State inmates

reported multiple impairments

An estimated 19% of State inmates

and 15% of Federal inmates reported

having one condition (either a physical

impairment or a mental condition).

Nearly 7% of State prisoners reported

two conditions and about 5% reported

having three or more. Among Federal

inmates, 5% said they had two conditions and 3% reported three or more.

3 or more 4.5 2.8

2 6.9 5.4

1 19.4 15.1

0 69.2 % 76.7 %

 Percent of inmates 

 State Federal

Number of physical

impairments or a

mental condition

Overall, 25% of State inmates and 21%

of Federal inmates reported that they

had multiple impairments or that their

impairment limited the kind or amount

of work they could do.

Over a quarter of State and Federal

inmates reported being injured

since admission to prison

In addition to being asked if they had

any physical impairments or a mental

or emotional condition, State and

Federal inmates were asked if they had

been injured in an accident or a fight

since their admission to prison. (See

the box above.)

Overall, an estimated 318,000 State

and Federal inmates reported being

injured since admission: 28% of State

inmates and 26% of Federal inmates

(table 3). About 20% of State inmates

and 23% of Federal inmates said they

had been injured in an accident; 10%

and 3%, respectively, said they had

been injured in a fight.

Among State inmates men (29%) were

more likely than women (21%) to report

being injured since admission. In

Federal prisons about a quarter of both

male (26%) and female (25%) inmates

reported being injured. In both State

and Federal prisons male and female

inmates reported similar rates of being

injured by an accident, while males in

both State and Federal prisons were

more likely to report being injured in a

4 Medical Problems of Inmates, 1997

45 or older 23.9 21.2 1.6

35-44 25.6 21.8 3.4

25-34 27.6 24.3 3.9

24 or younger 28.7% 25.5% 4.0%

 Age

 Female 24.8 22.9 0.6

 Male 26.3% 22.9% 3.4%

 Gender

 Total 26.2% 22.9% 3.2%

Federal prisoners

45 or older 21.9 15.8 6.5

35-44 27.4 19.7 9.3

25-34 30.1 21.8 10.6

24 or younger 29.5% 20.1% 12.8%

 Age

 Female 20.5 17.2 3.3

 Male 28.7% 20.3% 10.6%

 Gender

 Total 28.2% 20.1% 10.1%

State prisoners

Total In an accident In a fight

Percent of inmates who reported an injury since admission

Table 3. Percent of State and Federal inmates who reported an injury 

since admission, by gender and age, 1997

Key survey items on injuries of inmates since admission

Since your admission have you been injured?

1 â Yes 2 â No

Were you injured ...

 In a fight, assault, or where someone tried to harm you?

 1 â Yes 2 â No

 In an accident, for example, while working or playing sports?

 1 â Yes 2 â No
fight. About 11% of males in State

prisons and 3% of males in Federal

prisons reported being injured in a fight

compared to 3% and nearly 1% of

females, respectively.

Older inmates in State and Federal

prisons were less likely to have been

injured since their admission. Among

State prisoners age 24 or younger,

30% had been injured compared to

22% of those age 45 or older. Among

Federal prisoners 29% of those age 24

or younger compared to 24% of those

age 45 or older reported being injured

since admission. Inmates age 34 or

younger in both State and Federal

prisons were about twice as likely as

those age 45 or older to report being

injured in a fight since admission.

Likelihood of injury increases with

time served in prison

About 46% of State inmates and about

32% of Federal inmates who had

served at least 72 months at the time

of interview reported an injury compared to 13% of State and 17% of

Federal inmates who had served less

than 12 months (table 4).

The risk of being injured due to an

accident or in a fight increased with

time served (figure 1). About 10% of

State inmates and 16% of Federal

inmates who had served less than 12

months reported being injured in an

accident, compared to 32% of State

inmates and 26% of Federal inmates

who had served at least 72 months 

at the time of interview. 

State inmates who had served at least

72 months at the time of interview were

about 6 times as likely (20%) to report

being injured in a fight as those who

had served less than 12 months (3%),

and about 4 times as likely as those

who had served between 12 and 23

months (5%). Among Federal inmates,

those who had served at least 72

months were 5 times as likely (5%) to

report being injured in a fight as those

who had served less than 12 months

(1%). 

Regardless of amount of time served,

younger State inmates reported higher

rates of injury than older inmates

(figure 2). As the length of time served

 Medical Problems of Inmates, 1997 5

Figure 1

Figure 2

Figure 3

The Federal Bureau of Prison’s

medical records provide a basis for

examining official data of injuries

among Federal inmates. A medical

professional’s diagnosis determines

whether an inmate is classified as

being injured and the type of injury. 

In determining the number of inmates

injured, only the first injury is counted

for those with multiple injuries. 

Among Federal prison inmates,

official records show that in 1999,

3,134 were injured as the result of an

assault or a fight, and 25,975 were

injured while at work, during recreation, or in some other type of accident.

Estimates of injuries among Federal inmates based on official data

a

Percents are based on the average daily

population. If they were based on the total that

had spent any time in prison in 1999, the

percents would be lower.

b

BOP distinguishes occupational and recreational injuries from accidental injuries.

Accidental, other 7,859 6.7 b

Recreational 11,141 9.5

Occupational 6,844 5.8

Accidental, total 25,975 22.1

Assault/fight 3,134 2.7%

Percenta Injury Number

Federal inmates, 1999

0%

20%

40%

60%

Percent with injury

State inmates

Federal inmates

Injuries reported by inmates since

admission, by time serv ed

Time served in months

12 or 13- 25- 37- 49- 61- 73- 85- 97- 109-

less 24 36 48 60 72 84 96 108 120

72 mo or more 45.9 31.6 31.7 26.3 19.7 5.3

48-71 mo 36.8 30.2 26.3 25.3 13.8 5.4

24-47 mo 26.7 26.3 19.0 24.3 9.2 2.1

12-23 mo 19.8 22.0 14.8 20.1 5.3 1.8

Less than 12 mo 13.2% 17.0% 10.2% 15.6% 2.9% 0.8%

Time since admission State Federal State Federal State Federal

Total Injured in an accident Injured in a fight

Percent of inmates who reported an injury since admission

Table 4. Injuries reported by State and Federal inmates since admission, by time served, 1997

Time served in months

0%

20%

40%

60%

80%

Percent with injury

34 or

younger 35-44

Injuries reported by State inmates

since admission, by age and

time serv ed

Time served in months

12 or 13- 25- 37- 49- 61- 73- 85- 97- 109-

less 24 36 48 60 72 84 96 108 120

45 or older

Male inmates

0%

20%

40%

60%

Percent with injury

Female inmates

Injuries reported by State inmates

since admission, by gender and

time serv ed

Time served in months

12 or 13- 25- 37- 49- 61- 73- 85- 97- 109-

less 24 36 48 60 72 84 96 108 120

Male inmates
in prison increases, the prevalence of

injuries among inmates age 34 or

younger, inmates age 35-44, and

inmates age 45 or older increases.

However, while injuries increase in

each age group, inmates age 45 or

older consistently have the lowest rate

of injuries and those age 34 or younger

have the highest.

Men were more likely to have been

injured than women, regardless of the

length of time in prison. Only among

inmates who had served longer than 9

years are the percentages reporting an

injury higher among women than men

(figure 3). 

Inmates with a physical impairment

or mental condition were also more

likely to report an injury

State and Federal inmates with a

physical impairment more commonly

than those without a physical impairment reported being injured in an

accident since admission. Among

inmates with a physical impairment,

22% of those in State prisons and 25%

of those in Federal prisons reported

being injured in an accident compared

to 19% and 22%, respectively, of those

without a physical condition.

Inmates in State and Federal prisons

who reported having a mental condition

were more likely than those not report

ing a mental condition to be injured in 

a fight since admission. Nearly 16% 

of State inmates with a mental condition were injured in a fight compared 

to 10% without a mental condition.

Federal inmates who reported a mental

condition were about twice as likely

(6%) as those not reporting a mental

condition (3%) to say they had been

injured in a fight since admission.

No 20.0 22.6 9.5 3.0

Yes 20.7% 29.5% 15.7% 5.8%

Mental

No 19.2 22.4 9.4 2.9

Yes 22.5% 24.9% 12.2% 4.1%

Physical

State Federal State Federal

Injured in accident Injured in a fight

 Percent of inmates

 since admission

Physical

impairment

or mental

condition

Among State inmates those who

reported any impairment had higher

rates of injuries than other inmates,

regardless of how long they had served

in prison (figure 4).

Violent offenders more commonly

reported being injured in a fight

since admission

Among violent offenders about 14% of

those in State prisons and 9% of those

in Federal prisons reported being

injured in a fight since admission,

compared to less than 10% of other

State offenders and less than 5% of

other Federal offenders.

Public-order 14.3 21.2 5.9 3.8

Drug 14.8 23.2 4.1 1.7

Property 17.8 20.5 8.5 2.6

Violent 24.7% 24.8% 14.4% 9.4%

State Federal State Federal

Injured in accident Injured in a fight

 Percent of inmates 

 since admission 

Current

offense

Regardless of the time served in

prison, violent State prisoners had

higher rates of fight-related injuries

than other inmates (figure 5). Among

State inmates who had served less

than 12 months, 4% of violent offenders reported having been injured in a

fight, compared to 3% of nonviolent

offenders. However, among State

inmates who had served at least 72

months, 22% of violent inmates said

they had been injured in a fight

compared to 13% of nonviolent

inmates. 

About 22% of State inmates will be

injured while in prison

The survey data also provide an

estimate of an incoming inmate’s risk of

injury while in prison. Assuming that

incoming inmates will experience the

same chances of being injured as

those in prison at time of the survey,

nearly 22% of entering State inmates

are expected to be injured while in

prison. Overall, 7% of entering State

inmates are expected to be injured in a

fight while in prison.

The likelihood that an incoming inmate

will be injured at some time before

being released is estimated based on

the increasing percentage of inmates

who reported an injury while in prison. 

By weighting each reported percentage

injured within categories of time served

by the percent of inmates who are

expected to serve the specified amount

of time and then summing these

weights, we have calculated a

weighted average. This average represents the overall risk of inmates being

injured at some time while in prison.

6 Medical Problems of Inmates, 1997

Figure 4 Figure 5

Male inmates

0%

20%

40%

60%

Percent with injury

No impairment

Injuries reported by State inmates

since admission, by physical

impairment or mental condition

and time served

Time served in months

12 or 13- 25- 37- 49- 61- 73- 85- 97- 109-

less 24 36 48 60 72 84 96 108 120

Impairment

Percent with injury

Fight-related injuries reported

by State inmates since admission,

by offense and time serv ed

Violent
Weighted average 21.6% 6.8%

120 mo or more 7.6 46.1 21.3

73-119 2.7 45.6 18.6

61-72 2.4 42.0 15.6

49-60 3.5 34.6 13.7

37-48 4.8 29.3 10.5

25-36 8.0 25.4 8.3

13-24 21.6 19.9 5.7

7-12 27.4 16.2 3.5

6 mo or less 22.1% 11.0% 2.2%

Injury

in fight

Any

injury

Time expected

to be served

Percent of all

inmates

Percent of new

admissions*

Estimating the risk of injury

while in State prison 

*Based on data for inmates admitted in the 

6 months prior to the 1997 Survey of Inmates 

in State Correctional Facilities. 

More than 1 in 5 inmates in State

and Federal prisons reported a

medical problem excluding injury

since admission

Based on additional health-related

questions asked of inmates, more than

20% of both State and Federal inmates

said they had experienced a medical

problem other than an injury since their

admission to prison (table 5). This

problem may have reflected medical

conditions existing before admission.

Among State inmates nearly 8%

reported a medical problem that

required surgery, and 17% reported

some other medical problem. Among

Federal inmates about 10% reported

having a problem that required surgery,

and 16% said they had some other

medical problem.

The percentage of inmates who

reported requiring surgery or a specific

medical problem since admission

increased with the time served in

prison. State prisoners who had

served at least 72 months were about

5 times as likely to have had a medical

problem that required surgery and

about 2 times as likely to have had a

medical problem excluding injury than

those who had served less than 12

months (table 6). Among Federal

inmates who had served 72 or more

months at the time of interview, 18%

had required surgery, and 19% had

other medical problems, compared to

4% and 14% of those who had served

less than 12 months.

As with injuries, these reports may be

used to calculate the likelihood of

incoming inmates requiring surgery at

some time before being released from

prison. Assuming that incoming

inmates will experience the same

needs for surgery and have the same

incidence of medical problems as

those in prison at the time of the

survey, nearly 6% of all entering State

inmates are expected to need surgery

while in prison. In addition, nearly 16%

of entering State inmates will experience some other medical problem,

besides an injury, a cold, virus, or flu,

while in prison. (See Methodology for

calculations.)

 Medical Problems of Inmates, 1997 7

*Does not include colds, viruses, or cold-like symptoms.

Other 175,182 16.7 13,994 15.9

Required surgery 78,545 7.5 8,426 9.6

Medical problem (exclude injury) 224,033 21.4% 19,026 21.7%

Medical problem since admission*

Number Percent Number Percent

State inmates Federal inmates

Table 5. Estimated number and percent of State and Federal inmates

who reported a medical problem since admission, 1997

72 mo or more 30.4 28.6 15.9 17.5 21.1 18.8

48-71 mo 20.3 24.2 7.1 10.8 16.2 16.3

24-47 mo 20.4 17.2 5.9 6.3 16.5 13.6

12-23 mo 19.1 20.5 4.7 7.2 15.8 16.8

Less than 12 mo 15.8% 16.6% 3.2% 4.1% 13.7% 13.9%

State Federal State Federal State Federal

Time since Total Required surgery Other 

admission

Medical problem (exclude injury)

Percent of inmates who reported since admission

Table 6. Medical problems reported by State and Federal inmates since 

admission, by time served, 1997

The 1997 Survey of Inmates in State

and Federal Correctional Facilities

also included items on medical

problems other than physical impairments, mental or emotional problems,

and injuries since admission to prison.

Have you had any other medical problem?

(other than a physical impairment, a mental

or emotional problem, or injury since

admission)

1 â Yes 2 â No

Have you had a cold, virus, or the flu?

1 â Yes 2 â No

Have you had a health problem which

required surgery?

1 â Yes 2 â No

Have you had any other medical problem?

(asked 5 times)

1 â Yes 2 â No

Specify 

Excluding reports of a cold, virus, or

the flu, the most commonly reported

medical problems were grouped into

nine categories 

HIV/AIDS

Heart problems

6 Heart attack 6 Angina

Circulatory other than heart

6 Blood pressure 6 Stroke 6 Anemia

6 Aneurysm 6 Cholesterol

6 Vascular/veins 6 Blood clots/transfusions 

Cancer

Kidney/liver problems

6 Kidney 6 Liver 6 Hepatitis

Respiratory disorders

6 Lungs 6 Emphysema 6 Asthma

Neurological disorders

6 Seizures 6 Epilepsy

Skeletal

6 Back/spine 6 Joint 6 Arthritis

6 Muscle/ tendon 6 Bone spur 6 Fracture

Diabetes

Key survey items on medical problems of inmates since admission
Reported medical problems highest

among older, female inmates

Twenty-seven percent of female State

inmates and 30% of female Federal

inmates reported a medical problem

since admission (excluding injuries,

colds, viruses, and flu) compared to

21% of male State and Federal

inmates (table 7). In both State and

Federal prison, men and women were

equally likely to report having a medical

problem that required surgery since

their admission. A higher percentage

of female inmates reported other

medical problems since admission.

Among female inmates 23% of State

prisoners and 25% of Federal prisoners reported some other medical

problem compared to 16% of male

State inmates and 15% of male

Federal inmates. 

Older inmates in both State and

Federal prisons more commonly

reported medical problems requiring

surgery and other medical problems

since admission. Among those in State

prison 45 or older, 40% reported a

medical problem, compared to 12% of

those 24 or younger. Among State

inmates 45 or older, 16% reported

having a medical problem that required

surgery (compared to 3% of the

younger inmates) and 32% said they

had some other medical problem

(compared to 10%). Among Federal

inmates age 45 or older, 37% reported

a medical problem, 18% said they had

a medical problem that required

surgery and 29% reported some other

medical problem. 

About 1 in 6 State and Federal

inmates reported a medical problem

other than a cold, injury, or surgery

Inmates were asked to specify medical

problems that they have had since

admission to prison. The most

commonly reported medical problems

were then grouped into categories,

including HIV/AIDS, heart problems,

circulatory problems other than heart,

cancer, kidney/liver problems, respiratory problems, neurological problems,

skeletal problems, and diabetes. 

Among State and Federal inmates the

most commonly reported problems

since admission were skeletal and

circulatory other than heart. Skeletal

problems were reported by 2.6% of

State inmates and 3.1% of Federal

inmates, and 2.4% of both State and

Federal inmates said they had a circulatory problem other than heart 

(table 8). 

Other medical problems reported by

State and Federal inmates included

heart problems (1.1% and 1.3%),

cancer (0.2% and 0.3%), diabetes

(0.9% and 1.5%), HIV/AIDS (1.7% and

0.5%), kidney/liver problems ( 0.9%

and 1.4%), respiratory problems (1.4%

and 1.2%), and neurological problems

(0.7% and 0.4%).

8 Medical Problems of Inmates, 1997

45 or older 37.4 17.7 28.5

35-44 21.0 9.5 14.6

25-34 14.3 5.7 10.5

24 or younger 11.8% 4.1% 9.0%

Age

Female 30.1 11.3 24.7

Male 21.0% 9.5% 15.3%

Gender

Federal prisoners

45 or older 39.8 15.7 32.0

35-44 25.2 9.0 19.4

25-34 17.2 5.8 13.2

24 or younger 12.1% 3.3% 9.8%

Age

Female 27.2 7.9 22.7

Male 21.0% 7.5% 16.3%

Gender

State prisoners

Characteristics Total Required surgery Other 

Medical problem (excluding injury)

Percent of inmates who reported since admission

Table 7. Medical problems reported by State and Federal inmates since 

admission, by selected characteristics, 1997

The Federal Bureau of Prison’s

Sensitive Medical Data, which contain

information on the clinical status of

every inmate, provide an independent

source of information. Upon indication of a problem during a medical

screening, Federal inmates are

required to participate in a medical

clinic and to see medical staff on a

regular basis. 

Counts of the current clinical status of

inmates reveal significantly higher

rates than determined by inmate selfreports. At midyear 2000, the Federal

system had 5,639 inmates with

asthma (4.4% of all Federal inmates);

4,616 inmates in a diabetic clinic

(3.6%); 3,358 in a cardiac clinic

(2.6%); 10,011 in a hypertension

clinic (7.8%, and 6,151 in a mental

health clinic (4.8%).

Though collected at different times,

survey and official data suggest a

range for the prevalence of specific

problems. Official records based on

clinical schedules provide a high

estimate, since the records contain a

description of the original problem but

not the final diagnosis. Inmates may

provide a low estimate due to a lack

of understanding or unwillingness to

report.

*Based on the clinical status on July 29, 2000,

except for asthma, which was counted on

September 20, 2000. Inmate totals were based

on average daily population in each month.

Mental health 4.8 4.8

HIV/AIDS 1.0 0.5

High blood pressure 7.8 1.7

Heart 2.6 1.3

Diabetes 3.6 1.5

Asthma 4.4% 0.9%

1997

survey 

data

Official 

records, 

midyear 2000*

Medical 

problem

Percent of Federal inmates

Comparing estimates based on self-reported data to official records
Medical problems more prevalent

among inmates who had been

homeless or unemployed

Of State inmates who reported a period

of being homeless or living in a shelter

in the year before their arrest, nearly

half reported a physical impairment or

mental condition and about a third said

they had a medical problem (excluding

injury) since admission, compared to

29% and 26% of those who were not

homeless (table 9). 

State inmates who reported being

homeless at the time of their arrest

reported higher rates of medical

problems and physical impairments or

mental conditions than other inmates.

Thirty-five percent of State inmates

who were homeless when arrested

reported a medical problem excluding

injury since admission compared to

27% of those who were not homeless.

Half of State inmates who reported

being homeless at the time of the

arrest (51%) reported having a physical

impairment or mental condition.

Among State inmates who were not

homeless at time of arrest, 31% said

they had a physical impairment or

mental condition. 

Medical problems and physical impairments or mental conditions were also

more prevalent among inmates who

reported being unemployed before

their arrest and among inmates who

were receiving government assistance.

Nearly 35% of State inmates who were

unemployed in the month prior to their

arrest, compared to 29% of those who

were employed, reported having a

physical impairment or mental condition. Inmates who were unemployed

(27%) were as likely as those who

were employed to report having a

medical problem (excluding injury).

More than 1 in 3 of State inmates who

received financial support from government agencies in the month prior to

arrest reported a medical problem

since admission. More than a quarter

of State inmates who received income

from wages reported a medical

problem. 

Among inmates who reported receiving

income from government agencies,

52% of those in State prisons reported

having a physical impairment or mental

condition; among those who reported

receiving wages, 29%.

 Medical Problems of Inmates, 1997 9

a

History of drug abuse defined as used once a week or more for at least a month.

b

Measured by 3 or more positive CAGE responses. For description of the CAGE diagnostic measures 

and instrument see Substance Abuse and Treatment, State and Federal Prisoners, 1997.

No 28.7 19.8 28.7 25.9 7.3 20.4

Yes 37.7% 24.6% 26.6% 29.0% 8.1% 23.4%

Alcohol dependentb

No 29.7 19.8 28.2 25.3 7.0 19.9

Yes 35.9% 26.0% 28.2% 32.0% 9.6% 26.0%

Used needle to inject drugs

No 32.6 23.0 26.9 29.8 8.6 23.4

Yes 29.7% 19.4% 29.1% 24.4% 6.7% 19.5%

Used drugs in month before arrest

No 32.4 22.8 27.0 28.9 8.5 22.7

Yes 30.3% 20.2% 28.7% 25.8% 7.1% 20.5%

History of drug abusea

Other 30.4 19.8 32.1 25.7 7.2 20.7

Government transfers 52.3 41.1 25.0 36.7 9.2 31.7

Wages/salary 28.8% 18.5% 28.8% 26.3% 7.7% 20.4%

Source of income

No 34.5 25.3 26.7 26.6 6.9 21.7

Yes 29.3% 19.0% 28.6% 26.7% 7.8% 20.9%

Employed in month before offense

No 30.6 20.7 28.2 26.5 7.5 21.0

Yes 50.5% 33.6% 18.1% 34.9% 5.3% 32.3%

At time of arrest

No 29.2 20.0 28.1 26.1 7.4 20.6

Yes 45.1% 28.8% 27.1% 30.8% 7.8% 25.3%

In year before arrest

Homeless

Any Limits ability to work Total Required surgery Other

Injury since Other medical problem since admission

admission

Physical impairment or mental condition

Percent of inmates who reported &

Table 9. Medical problems reported by State inmates, by selected background characteristics, 1997

*Includes other medical problems 

not reported separately.

Diabetes 0.9 1.5

Skeletal 2.6 3.1

Neurological 0.7 0.4

Respiratory 1.4 1.2

Kidney/Liver 0.9 1.4

Cancer 0.2 0.3

2.4 2.4

Circulatory other

than heart

Heart 1.1 1.3

HIV/AIDS 1.7 0.5

 Total* 16.7% 15.9%

Federal

inmates

State

inmates

Table 8. Specific medical problems

reported by State and Federal

inmates since admission, 1997
Medical problems more common

among inmates who had used a

needle to inject drugs and those

who were alcohol dependent

An estimated 32% of State inmates

who reported ever using a needle to

inject drugs said they had a medical

problem (excluding injury) since admission to prison, compared to 25% of

those who did not use a needle.

Inmates who reported ever using a

needle to inject drugs reported a higher

prevalence of physical impairments or

mental conditions. Among State

prisoners, about 36% of those who

used a needle and 30% of those who

did not use a needle to inject drugs

reported having some physical impairment or mental condition. 

Overall, State inmates who reported a

history of drug abuse were as likely as

those who said they never used drugs

to report having a medical problem

since admission and to report having a

physical impairment or mental

condition.

Nearly 38% of State inmates who were

alcohol dependent reported having a

physical impairment or mental condition, compared to 29% of those who

were not alcohol dependent. Based 

on the CAGE diagnostic inmates are

considered alcohol dependent if they

answer yes to three or more of the

following questions: ever attempt to

cut back on drinking, ever annoyed by

others’ criticism of your drinking, ever

felt guilty about drinking, and ever drink

first thing in the morning?

Methodology

Survey of Inmates in State and Federal

Correctional Facilities, 1997

Data in this report are based primarily

on personal interviews with State and

Federal inmates. In the 1997 Surveys

of Inmates in State and Federal

Correctional Facilities, offenders were

randomly selected from a nationally

representative sample of facilities and

were asked questions regarding their

current offense and sentence, criminal

history, personal and family background, physical impairment and

mental condition, and medical

problems since admission to prison.

Detailed descriptions of the methodology and sample design can be found in

Substance Abuse and Treatment of

State and Federal Prisoners, 1997,

BJS Special Report, NCJ 172871.

Accuracy of the survey estimates

The accuracy of the survey estimates

presented in this report depends on two

types of error: sampling and nonsampling. Sampling error is the variation that

may occur by chance because a sample

rather than a complete numeration of the

population was conducted. Nonsampling

error can be attributed to many sources,

such as nonresponses, differences in the

interpretation of questions among

inmates, recall difficulties, and processing

errors. In any survey the full extent of the

nonsampling error is never known. 

The sampling error, as measured by an

estimated standard error, varies by the

size of the estimate and the size of the

base population. Estimates of the

standard errors for selected characteristics have been calculated for 1997

Surveys of Inmates in State and Federal

Correctional Facilities (see appendix

tables). These standard errors may be

used to construct confidence intervals

around estimated percentages. For

example, the 95%-confidence interval

around the percentage of State prison

inmates who reported having any physical impairment or mental condition is

approximately 31.0% plus or minus 1.96

times 0.50% (or 30.0% to 32.0%).

10 Medical Problems of Inmates, 1997

Inmates were asked questions on

medical services provided by the

prison facility at the time of admission

and since admission. More than 8

out of 10 State inmates reported

having a medical exam since being

admitted to prison. Nearly 60% of

State inmates reported being

checked by staff to see if they were

sick, injured or intoxicated at time of

admission; about 82% were asked

questions about their health or medical history. The medical services

provided at admission to those

inmates who reported later medical

problems did not differ from that

given to inmates with no reported

medical problems.

Among State inmates who reported

any medical problem since admission

to prison, 91% reported visiting a

health care professional because of

their medical problem. Among

inmates who had been injured, 87%

reported seeing a health care professional, as did 96% of those who said

they had a problem that required

surgery.

85.0

Have you had a medical

exam?

86.7

Have you had a blood

test for any reason?

96.2%

Has anyone pricked your 

skin to test for TB?

Since admission

81.4

Staff asked if you had ever

thought about suicide?

82.3

Staff asked questions

about your health or

medical history?

59.7 %

Staff checked to see if

you were sick, injured,

or intoxicated?

At time of admission

Percent of all

Medical service provided State inmates

Other medical problem 92.7

Surgery 95.9

Injury 87.2

 Total 91.2%

Percent of State 

inmates who reported 

medical problem and

saw a health care

professional

Summary of medical services provided to State prisoners
These standard errors may also be used

to test the statistical significance of the

difference between two sample statistics

by pooling the standard errors of the two

sample estimates. For example, the

standard error of the difference between

male and female State inmates who

report having a physical impairment or

mental condition would be .59% (or the

square root of the sum of the squared

standard errors for each group). The

95%-confidence interval around the

difference would be 1.96 times .59% (or

1.2%). Since the difference of 3.7%

(34.4% minus 30.7%) is greater than

1.2%, the difference would be considered

statistically significant.

National Adult Literacy Survey, 1992

Questions on physical impairments and

mental conditions in the BJS surveys

were adapted from the National Adult

Literacy Survey, conducted by the

National Center for Education Statistics

in 1992. Interviews were completed

with nearly 1,150 inmates in 80 State

and Federal prisons and a nationally

representative sample of about 13,600

adults age 16 and older. Both prisons

and inmates were randomly selected to

be representative of prisons across the

country. (For an overview of the

survey design, statistical procedures,

and other findings, see Literacy Behind

Prison Walls, National Center for Education Statistics, Washington, DC, October

1994.)

National Health Interview Survey, 1996

To compare the prevalence of medical

problems among inmates with the

prevalence of medical problems in the

general U.S. population, data were

drawn from the National Health Interview Survey, 1996. (See Current

Estimates From the National Health

Interview Survey, 1996, National

Center for Health Statistics, PHS

99-1528, October 1999). The survey,

conducted yearly, is based on in-home

interviews of the civilian noninstitutionalized U.S. population. Estimates were

provided on, but were not limited to,

prevalence of chronic conditions. For

purposes of the survey, chronic conditions were defined as conditions that

had been first noticed 3 or more

months prior to the interview or belong

to a group of conditions that are

considered chronic regardless of onset.

Comparisons with the general U.S.

population are sharply affected by

differences in the demographic characteristics of State and Federal inmates,

who are disproportionately male and

middle-aged. To control for these

differences, estimates of the percentage of the U.S. population with

selected physical impairments were

calculated by standardizing the general

population to resemble the age and

gender distribution of State inmates.

Age-standardized rates for males were

calculated by multiplying the rate of

males in the general population reporting a physical impairment within specified age groups by the proportion of

male State prisoners in each respective age group and then summing. The

same was done for females in the

general population. To calculate the

overall age and gender standardized

rate, the age-standardized rate for

males was then multiplied by the

proportion of males in State prisons

and added to the result of the

age-standardized rate for females

multiplied by the proportion of females

in State prisons. 

Weighted average 13.8

65 or older 0.70 15.2

45-64 12.09 7.9

18-44 86.75 14.6

17 or younger 0.46% 16.3

Rate per 100 

in the general

population

Percent in

State prison

population

Standardizing the rate of speech

impairment among males

Estimating the likelihood that an inmate

will be injured or will require surgery 

at some time while in prison

Prevalence rates may be used to

estimate the likelihood that inmates will

be injured or require surgery at some

time prior to their release. Such

estimates assume that incoming

 Medical Problems of Inmates, 1997 11

Other 0.41 0.77

Required surgery 0.29 0.62

Medical problem 0.45 0.87

(exclude injury)

Injury 0.49% 0.92%

Medical problem

since admission

Physical 0.35 0.66

Mental 0.33 0.45

Vision 0.30 0.56

Hearing 0.25 0.48

Speech 0.21 0.31

Learning 0.33 0.46

Any condition 0.50% 0.89%

Physical impairment of mental

condition

State Federal

Standard error for

estimated percentages

Appendix table 1. Standard errors 

of inmates who reported a physical

impairment or mental condition or 

a medical problem

45 or older 0.53 1.02 0.54 1.02

35-44 0.47 0.86 0.52 0.87

25-34 0.41 0.74 0.48 0.78

24 or younger 0.36% 0.68% 0.46% 0.72%

Age

Female 0.25 0.50 0.27 0.50

Male 0.46% 0.88% 0.52% 0.91%

Gender

 State Federal State Federal

Medical problems (exclude injury) Physical impairment or mental condition

Standard error for estimated percentages 

Appendix table 2. Standard errors of inmates who reported a physical 

impairment or mental condition or a medical problem, by gender and age

72 mo or more 0.56 0.99 0.51 0.96

48-71 mo 0.54 0.98 0.45 0.91

24-47 mo 0.49 0.94 0.45 0.80

12-23 mo 0.44 0.88 0.44 0.86

Less than 12 mo 0.38% 0.80% 0.41% 0.79%

State Federal State Federal

Injured Medical problems (exclude injury)

Standard error for estimated percentages 

Appendix table 3. Standard errors of inmates who reported a physical 

impairment or mental condition or a medical problem, by time served
inmates will experience the same

chances of injury or the same need for

surgery as those in prison at the time

of the interview. 

For example, the expected need for

surgery among incoming inmates

(5.8%) was estimated by weighting

each reported percent requiring

surgery within categories of time

served by the percent of inmates who

are expected to serve the specified

amount of time and then summing. 

Weighted average 5.8% 15.6%

120 mo or more 7.6 21.0 22.6

73-119 2.7 12.4 20.1

61-72 2.4 8.0 16.5

49-60 3.5 6.6 15.8

37-48 4.8 6.1 17.1

25-36 8.0 6.0 16.3

13-24 21.6 4.7 15.7

7-12 27.4 4.2 14.2

6 mo or less 22.1% 2.5% 13.6%

Other

medical

problem 

Required

surgery

Time 

expected to

be served

Percent of State 

inmates in survey

Percent 

of new

admissions*

*Based on data for inmates admitted in the 

6 months prior to the 1997 Survey of Inmates 

in State Correctional Facilities.

12 Medical Problems of Inmates, 1997

This report and others from the

Bureau of Justice Statistics are 

available through the Internet 

http://www.ojp.usdoj.gov/bjs/

The data from the 1997 Surveys of

Inmates in State and Federal

Correctional Facilities are available

from the National Archive of Criminal

Justice Data, maintained by the 

Institute for Social Research at the

University of Michigan, 1-800-999-

0960. The archive may also be

accessed through the BJS Internet

site. 

The Bureau of Justice Statistics

is the statistical agency of the 

U.S. Department of Justice. 

Jan M. Chaiken, Ph.D., is director.

BJS Special Reports address a 

specific topic in depth from one or 

more datasets that cover many

topics.

Laura M. Maruschak and Allen J.

Beck wrote this report. Christopher

J. Mumola provided statistical assistance. Tom Hester edited the report.

Tina Dorsey prepared the report for

publication.

January 2001, NCJ 181644