Binswanger Ingrid A, Stern Marc F, Deyo Richard A, Heagerty Patrick J, Cheadle Allen, Elmore Joann G, Koepsell Thomas D
Puget Sound Veterans Affairs Medical Center, Seattle, USA.
N Engl J Med. 2007 Jan 11;356(2):157-65. doi: 10.1056/NEJMsa064115.
The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.
We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race.
Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after 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 among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.
Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.
美国有大量且数量不断增加的曾经入狱的人群。刚获释后的这段时期对这些曾经入狱的人来说可能颇具挑战，且可能涉及重大健康风险。我们研究了华盛顿州监狱释放的曾经入狱者在获释后不久的死亡风险。
我们对1999年7月至2003年12月从华盛顿州惩教部获释的所有囚犯进行了一项回顾性队列研究。监狱记录与国家死亡索引相链接。与华盛顿州居民进行比较的数据来自疾病控制和预防中心的广泛在线流行病学研究数据系统。通过间接标准化以及对年龄、性别和种族进行调整，将曾经入狱者的死亡率与其他州居民的死亡率进行比较。
在30237名获释囚犯中，443人在平均1.9年的随访期内死亡。总体死亡率为每10万人年777例死亡。曾经入狱者经调整后的死亡风险是其他州居民的3.5倍（95%置信区间[CI]，3.2至3.8）。在获释后的前两周内，曾经入狱者的死亡风险是其他州居民的12.7倍（95%CI，9.2至17.4），因药物过量导致的死亡相对风险显著升高（129；95%CI，89至186）。曾经入狱者的主要死亡原因是药物过量、心血管疾病、凶杀和自杀。
曾经入狱者在出狱后死亡风险很高，尤其是在头两周。有必要采取干预措施以降低出狱后的死亡风险。
