Release from Prison — A High Risk of Death for Former Inmates
Ingrid A. Binswanger, M.D., Marc F. Stern, M.D., Richard A. Deyo, M.D., Patrick J. Heagerty, Ph.D., Allen Cheadle, Ph.D., Joann G. Elmore, M.D., and Thomas D. Koepsell, M.D.
Background The U.S. population of former prison inmates is largeand growing. The period immediately after release may be challengingfor former inmates and may involve substantial health risks.We studied the risk of death among former inmates soon aftertheir release from Washington State prisons.
Methods We conducted a retrospective cohort study of all inmatesreleased from the Washington State Department of Correctionsfrom July 1999 through December 2003. Prison records were linkedto the National Death Index. Data for comparison with WashingtonState residents were obtained from the Wide-ranging OnLine Datafor Epidemiologic Research system of the Centers for DiseaseControl and Prevention. Mortality rates among former inmateswere compared with those among other state residents with theuse of indirect standardization and adjustment for age, sex,and race.
Results Of 30,237 released inmates, 443 died during a mean follow-upperiod of 1.9 years. The overall mortality rate was 777 deathsper 100,000 person-years. The adjusted risk of death among formerinmates was 3.5 times that among other state residents (95%confidence interval [CI], 3.2 to 3.8). During the first 2 weeksafter release, the risk of death among former inmates was 12.7(95% CI, 9.2 to 17.4) times that among other state residents,with a markedly elevated relative risk of death from drug overdose(129; 95% CI, 89 to 186). The leading causes of death amongformer inmates were drug overdose, cardiovascular disease, homicide,and suicide.
Conclusions Former prison inmates were at high risk for deathafter release from prison, particularly during the first 2 weeks.Interventions are necessary to reduce the risk of death afterrelease from prison.
Source Information
From the Puget Sound Veterans Affairs Medical Center, Seattle (I.A.B., T.D.K.); the Departments of Medicine (I.A.B., R.A.D., J.G.E.), Health Services (I.A.B., R.A.D., A.C., T.D.K.), Biostatistics (P.J.H.), and Epidemiology (J.G.E., T.D.K.), University of Washington, Seattle; the Department of Medicine, University of Colorado at Denver and the Health Sciences Center, Denver (I.A.B.); and the Washington State Department of Corrections, Olympia (M.F.S.).
Address reprint requests to Dr. Binswanger at the Department of Medicine, Division of General Internal Medicine, University of Colorado at Denver and the Health Sciences Center, 4200 E. Ninth Ave., B180, Denver, CO 80262, or at ingrid.binswanger{at}uchsc.edu.
Mortality after Release from Prison
Spaulding A. C., Allen S. A., Stone A., Coffin P. O., Wines J. D. Jr., Saitz R., Samet J. H., Binswanger I., Stern M. F., Elmore J. G.
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N Engl J Med 2007;
356:1785-1787, Apr 26, 2007.
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A correction has been published: N Engl J Med 2007;356(5):536.
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