Clinical risk factors for death after release from prison in Washington State: a nested case–control study

Abstract

Background and aims While mortality rates after prison release are high, little is known about clinical risk factors for death. We sought to identify risk and protective factors for all-cause and accidental poisoning (overdose) death. Design Nested case control study of people released from prison. Setting Washington State Department of Corrections, Washington, USA. Participants Cases (699 all-cause deaths, of which 88 were among women, and 206 additional overdose deaths, of which 76 were among women) between 1999 and 2009 matched 1:1 to controls on sex, age and year of release using risk set sampling. Measurements Prison medical charts were abstracted for clinical information. Independent associations between clinical characteristics and all-cause and overdose mortality were assessed using conditional logistic regression. Findings Key independent risk factors for all-cause mortality included homelessness (Odds Ratio [OR] 1.53, 95% Confidence Interval [CI] 1.06, 2.23), injection drug use (OR 1.54, 95% CI 1.15, 2.05), tobacco use (OR 1.50, 95% CI 1.06, 2.12), cirrhosis (OR 4.42, 95% CI 1.63, 11.98), and psychiatric medications before release (OR 2.37, 95% CI 1.71, 3.29). Independent risk factors for overdose mortality included substance dependence (OR 2.33, 95% CI 1.32, 4.11), injection drug use (OR 2.43, 95% CI 1.53, 3.86), panic disorder (OR 3.87, 95% CI 1.62, 9.21), psychiatric prescriptions before release (OR 2.44, 95% CI 1.55, 3.85), and problems with opiates/sedatives (OR 2.81, 95% CI 1.40, 5.63). Substance use disorder treatment during the index incarceration was protective for all-cause (OR 0.67, 95% CI 0.49, 0.91) and overdose (OR 0.57, 95% CI 0.35, 0.90) mortality. Conclusions Injection drug use and substance use disorders are risk factors for death after release from prison. In-prison substance use treatment services may reduce the risk.

Incidence and risk factors for mortality after release from prison in Australia: a prospective cohort study

“…In a study of 699 cases and 699 matched controls in the United States, identified risk factors for all‐cause mortality included a history of homelessness, injecting drug use, tobacco use, cirrhosis and use of psychiatric medications before release from custody. Substance use disorder treatment in prison was protective . In a similar study of 286 cases and 286 matched controls in Australia, risk factors for external causes of death included use of heroin and other opioids before incarceration, risky drinking before incarceration, use of anti‐depressants in prison and having served two or more prison sentences.…”

Commentary on Binswanger et al. (2016): Multiple opportunities exist to improve the health and wellbeing of people released from prisons

“…The findings in Binswanger et al [13] also highlight the importance of interventions that go beyond prison walls to provide support as people transition from custody to the community. Release to homelessness was a risk factor for post-release death, raising important questions about the quality of transitional care provided to people leaving custody, and indeed the ethical obligations of correctional authorities to ensure that the basic survival needs of people who have been in their care will be met after release.…”

“…In Binswanger et al, cirrhosis during incarceration was the factor associated with the greatest increase in odds of post-release death from any cause [13]. In a correctional population, some cirrhosis will be due to HCV infection subsequent to injecting drug use [14].…”

“…Binswanger et al provide some indication of targets for such interventions with their case-control study of clinical risk factors for post-release mortality of prisoners in Washington State, USA [13]. In this study, individuals released from prisons who died between 1999 and 2009 were matched to people released from prisons and still living.…”

Mental Health Providers’ Attitudes About Criminal Justice–Involved Clients With Serious Mental Illness

“…Between 2008 and 2014, 25%–27% of people with serious mental illness reported being arrested in their lifetime, compared with 17%–18% of those without serious mental illness (1). After release from correctional supervision, people with and without serious mental illness are at elevated risk of poor health outcomes, including poorly controlled behavioral and somatic conditions, drug overdose, and premature mortality (2,3). …”