Wobeser Wendy L, Datema Jason, Bechard Benoit, Ford Peter
Department of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON.
CMAJ. 2002 Nov 12;167(10):1109-13.
People in custody are more likely to die prematurely, especially of violent causes, than similar people not in custody. Some of these deaths may be preventable. In this study we examined causes of death (violent and natural) among people in custody in Ontario. We also compared the causes of deaths in 3 custodial systems (federal penitentiaries, provincial prisons and police cells).
We examined all available files of coroners' inquests into the deaths of people in custody in federal penitentiaries, provincial prisons and police cells in Ontario from 1990 to 1999. Data collected included age, cause of death, place of death, history of psychiatric illness and history of substance abuse. Causes of death were categorized as violent (accidental poisoning, suicide or homicide) or natural (cancer, cardiovascular disease or "other"). Crude death rates were estimated for male inmate populations in federal and provincial institutions. There were inadequate numbers for women and inadequate denominator estimates for police cells.
A total of 308 inmates died in custody during the study period; data were available for 291 (283 men, 8 women). Of the 283 deaths involving men, over half (168 [59%]) were from violent causes: suicide by strangulation (n = 90), poisoning or toxic effect (n = 48) and homicide (n = 16). Natural causes accounted for 115 (41%) of the deaths among the men, cardiovascular disease being the most common (n = 62 cases) and cancer the second most common (n = 18). Most (137 [48%]) of the deaths among the men occurred in federal institutions; 88 (31%) and 58 (21%) respectively occurred in provincial institutions and police cells. The crude rate of death among male inmates was 420.1 per 100,000 in federal institutions and 211.5 per 100 000 in provincial institutions. Compared with the Canadian male population, male inmates in both federal and provincial institutions had much higher rates of death by poisoning and suicide; the same was true for the rate of death by homicide among male inmates in federal institutions. The rates of death from cardiovascular disease among male inmates in federal and provincial institutions -- 102.7 and 51.7 per 100,000 respectively -- were also higher than the national average.
Violent causes of death, especially suicide by strangulation and poisoning, predominate among people in custody. Compared with the Canadian male population, male inmates have a higher overall rate of death and a much higher rate of death from violent causes.
被拘留者比未被拘留的类似人群更容易过早死亡，尤其是死于暴力原因。其中一些死亡可能是可以预防的。在本研究中，我们调查了安大略省被拘留者的死亡原因（暴力和自然原因）。我们还比较了三种拘留系统（联邦监狱、省级监狱和警察拘留所）中的死亡原因。
我们查阅了1990年至1999年安大略省联邦监狱、省级监狱和警察拘留所中被拘留者死亡的验尸官调查的所有可用档案。收集的数据包括年龄、死亡原因、死亡地点、精神疾病史和药物滥用史。死亡原因分为暴力（意外中毒、自杀或他杀）或自然（癌症、心血管疾病或“其他”）。估计了联邦和省级机构男性囚犯群体的粗死亡率。女性人数不足，警察拘留所的分母估计数也不足。
在研究期间，共有308名囚犯在拘留期间死亡；291人的数据可用（283名男性，8名女性）。在283例男性死亡中，超过一半（168例[59%]）死于暴力原因：勒死自杀（n = 90）、中毒或毒性作用（n = 48）和他杀（n = 16）。自然原因占男性死亡人数的115例（41%），心血管疾病最为常见（n = 62例），癌症次之（n = 18例）。男性死亡中大多数（137例[48%]）发生在联邦机构；分别有88例（31%）和58例（21%）发生在省级机构和警察拘留所。联邦机构男性囚犯的粗死亡率为每10万人420.1例，省级机构为每10万人211.5例。与加拿大男性人口相比，联邦和省级机构中的男性囚犯中毒和自杀死亡率要高得多；联邦机构中男性囚犯的他杀死亡率也是如此。联邦和省级机构中男性囚犯的心血管疾病死亡率分别为每10万人102.7例和51.7例，也高于全国平均水平。
暴力死亡原因，尤其是勒死自杀和中毒，在被拘留者中占主导地位。与加拿大男性人口相比，男性囚犯的总体死亡率更高，暴力死亡发生率也高得多。
