For a NEJM report entitled Release from Prison – A High Risk of Death of Former Inmates, the authors reviewed data related to 30,237 prisoners released from the Washington Department of Corrections (DOC) between July 1, 1999 and December 31, 2003.
The results were alarming. Within a mean follow-up period of 1.9 years after being released, 443 of the former prisoners died. Of those, 253 died within a year after they left prison. The overall mortality rate for former prisoners was 777 per 100,000 person-years, or almost 3.5 times higher than the rate for people not released from prison, which was calculated at 223 per 100,000.
The primary cause of death among ex-prisoners tracked in the NEJM study was drug overdose, accounting for about a quarter of all fatalities. Of those, 27 occurred within two weeks of release. Cocaine was involved in most overdose-related deaths, followed by methamphetamine, heroin, methadone and antidepressants.
The second major cause of death was cardiovascular disease. Homicide ranked third, followed by suicide, cancer and motor vehicle accidents.
Deaths caused by overdose, homicide and suicide were predominant in released prisoners under the age of 45, while cardiovascular disease and cancer-related deaths were more common in those 45 and older.
Surprisingly, in-prison mortality rates were much lower than those among ex-prisoners – there were only 192 deaths per 100,000 Washington State prisoners between 2001 and 2002. The difference in rates between in-prison deaths and deaths of released prisoners was attributed to “fewer overdoses, homicides, and motor vehicle accidents during incarceration,” according to the NEJM study.
The report was careful to emphasize that it had only sampled data from prisoners released from the Washington DOC. Death rates among former prisoners may be higher or lower on a more general scale, the authors noted.
Nonetheless, the study recommended the adoption of “interventions aimed at decreasing the risk of death” for released prisoners, including better transition planning, education related to drug use, and preventative care to address cardiac risks. In conclusion, the authors wrote, such interventions might not only help prisoners but also produce “secondary benefits for society ... in the form of increased public safety.”
The results of the NEJM report were revisited in another study published in the American Journal of Public Health (AJPH), titled All-Cause and Cause-Specific Mortality Among Men Released From State Prison, 1980–2005. In that report, the authors reviewed the deaths of male prisoners released from the North Carolina DOC over a 25-year period, and concluded that the standardized morality ratio (SMR) for former prisoners “was greater than for other male North Carolina residents.”
Specifically, released prisoners were found to be more likely to die due to homicide, accidents, HIV, substance abuse, liver cancer and liver disease. Where the expected SMR within a given population is expressed as 1.0, the SMR for re-leased white prisoners was 2.08; for released black prisoners it was 1.03.
The AJPH study noted that the higher morality ratios reflected “ex-prisoners’ medical vulnerability and the need to improve correctional and community preventive health services.”
Sources: www. nejm.com, www.ajph.aphapublications.org
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