The association between age and functional disability in US adults with lifetime exposure to the criminal legal system, 2015–2019

Importance: As the global population ages, the proportion of individuals living with functional disability is increasing. Evidence suggests that functional disability is associated with worse health outcomes and is concentrated in populations with high rates of concurrent social risk factors such as criminal legal involvement (CLI), making it an increasingly important issue for advocates of health equity. Objective: To determine whether age is associated with functional disability in a nationally representative sample of United States adults with lifetime exposure to the criminal legal system. Design: Cross-sectional survey data from the National Survey of Drug Use and Health, 2015–2019. Setting: Nationally representative survey data. Participants: US adults who reported lifetime history of arrest (N = 37,279). Exposure: Respondents were categorized into age groups: younger adults (age 18–49); middle-aged adults (age 50–64); and older adults (age ≥ 65). Main outcome measure: Functional disability as measure by the World Health Organization Disability Assessment Score 2.0 (WHO-DAS 2.0). A higher score indicates a greater degree of functional disability. Results: The sample included 37,279 US adults with lifetime CLI of whom 60.0 % were younger adults, 28.5 % were middle-aged adults, and 11.5 % were older adults. The mean, unadjusted functional disability score for younger adults was 5.0 (95 % CI, 4.9, 5.1); for middle-aged adults it was 4.2 (95 % CI, 4.0, 4.4); and for older adults it was 3.2 (95 % CI, 2.9, 3.5). In models adjusted for sociodemographic and clinical confounders, differences were attenuated but remained statistically significant, indicating increased functional disability in the younger age groups. Conclusion and relevance: Our findings suggest that among adults with CLI, functional disability is distributed by age in a pattern distinct from the general population. A large number of young adults have CLI, and the findings suggest that prevalence of functional disability is exceedingly high in this marginalized group. Future studies should examine if substance use and mental health conditions contribute to these findings, and policy makers should examine if flexible interventions tailored to the needs of those with disability improve reentry outcomes for young adults with CLI.