County health rankings, provider shortages, and the health of incarcerated women with opioid use disorder

Purpose: Incarcerated women in rural Kentucky face significant barriers to healthcare, including provider shortages, geographic isolation, and limited access to preventive services. This study examines how county health rankings and primary care provider (PCP) availability relate to women's self-reported health conditions and healthcare utilization prior to incarceration (PIT). Methods: A total of 900 incarcerated women across nine Kentucky jails were screened for opioid use disorder and enrolled as part of a larger clinical trial. County-level data, including 2023 County Health Rankings and 2022 PCP-to-population ratios, were merged with self-reported data on health conditions and service use PIT. Logistic regression models assessed associations between county-level indicators and pre-incarceration healthcare utilization and health status. Findings: On average, women were 37.3 years old, 92.6% non-Hispanic White, and 67.1% lived in a rural county before jail. Women from counties with better health rankings were more likely to access substance use treatment (AOR = 0.993, p = 0.028) before incarceration. Those from counties with poorer rankings were more likely to report hepatitis C (AOR = 1.008, p = 0.002) but less likely to report other health concerns, possibly reflecting reduced access or awareness. Fewer available PCPs were associated with higher rates of chronic conditions, such as issues with blood pressure (e.g., hypertension; AOR = 0.782, p = 0.010). Conclusion: County-level disparities in healthcare infrastructure may significantly affect the health of women involved in the criminal legal system. Strengthening provider networks, expanding telehealth, and investing in rural health systems are critical to improving access and outcomes for this vulnerable population and may reduce recidivism and adverse post-release health events.