Criminal legal involvement history linked to higher emergency department visits

People with a history of criminal legal involvement have higher odds of visiting an emergency department (ED), particularly for substance use and mental health reasons, according to a new study published July 8, 2026 in the open access journal PLOS One by Vidya Eswaran of Washington University in St. Louis, US, and colleagues.

Criminal legal involvement (CLI), defined as ever having been arrested and booked for breaking the law, is a known predictor of adverse health outcomes, with incarcerated individuals suffering a high burden of chronic medical conditions and comorbidities. Previous studies on ED utilization among people with CLI have focused on cohorts with known and recent incarcerations rather than those with a lifetime history of CLI.

In the new work, researchers used data from 139,524 adults who participated in the 2021–2023 National Survey on Drug Use and Health, a nationally representative, cross-sectional survey of civilian, non-institutionalized U.S. residents. Participants self-reported any lifetime and past-year CLI as well as ED visits in the prior 12 months for any reason, for substance use, and for mental health.

Of those who reported an ED visit for any reason, 19% reported lifetime CLI and 3% reported past-year CLI. These proportions were higher for substance use-related ED visits (44% lifetime CLI; 15% past-year CLI) and mental health-related ED visits (29% lifetime CLI; 8% past-year CLI). After adjusting for sociodemographic and behavioral health factors, those with lifetime CLI had higher odds of an ED visit for any reason (aOR 1.20, 95% CI 1.12–1.29), for substance use (aOR 1.82, 95% CI 1.36–2.43), and for mental health (aOR 1.54, 95% CI 1.19–1.99).

Because the survey excludes currently incarcerated and housing-insecure individuals, two populations more likely to have CLI and to use EDs, the true prevalence of CLI among ED patients may be higher than these findings suggest. The authors conclude that CLI history should be recognized as a social determinant of health that shapes patterns of ED use, particularly for substance use and mental health care.

The authors add: "In a nationally representative survey 1 in 5 individuals who have visited an Emergency Department (ED) report a history of lifetime criminal legal involvement (CLI), which is associated with adverse health outcomes. EDs are uniquely positioned to help address health disparities and should be considered as sites of screening and intervention in collaboration with community partners focused on improving outcomes in this population."