Binswanger Ingrid A, Blatchford Patrick J, Forsyth Simon J, Stern Marc F, Kinner Stuart A
Kaiser Permanente Colorado, Institute for Health Research, Denver, CO; University of Colorado Denver, School of Medicine, Department of Psychiatry, Division of General Internal Medicine, Aurora, CO.
University of Colorado Denver, Colorado School of Public Health, Department of Biostatistics and Informatics, Denver, CO.
Public Health Rep. 2016 Jul-Aug;131(4):574-82. doi: 10.1177/0033354916662216.
People in prison may be at high risk for infectious diseases and have an elevated risk of death immediately after release compared with later; their risk of death is elevated for at least a decade after release. We compared rates, characteristics, and prison-related risk factors for infectious disease-related mortality among people released from prisons in Queensland, Australia, and Washington State, United States, regions with analogous available data.
We analyzed data from retrospective cohort studies of people released from prison in Queensland (1997-2007, n=37,180) and Washington State (1999-2009, n=76,208) and linked identifiers from each cohort to its respective national death index. We estimated infectious disease-related mortality rates (deaths per person-years in community) and examined associations using Cox proportional hazard models.
The most frequent infectious disease-related underlying cause of death after release from prison was pneumonia (43%, 23/54 deaths) in the Australian cohort and viral hepatitis (40%, 69/171 deaths) in the U.S. cohort. The infectious disease-related mortality rate was significantly higher in the U.S. cohort than in the Australian cohort (51.2 vs. 26.5 deaths per 100,000 person-years; incidence rate ratio = 1.93, 95% confidence interval 1.42, 2.62). In both cohorts, increasing age was strongly associated with mortality from infectious diseases.
Differences in the epidemiology of infectious disease-related mortality among people released from prison may reflect differences in patterns of community health service delivery in each region. These findings highlight the importance of preventing and treating hepatitis C and other infectious diseases during the transition from prison to the community.
与之后相比，监狱中的人可能面临较高的传染病风险，且在获释后立即死亡的风险更高；他们在获释后的至少十年内死亡风险都有所升高。我们比较了澳大利亚昆士兰州和美国华盛顿州监狱释放人员中与传染病相关的死亡率、特征及与监狱相关的风险因素，这两个地区有类似的可用数据。
我们分析了昆士兰州（1997 - 2007年，n = 37180）和华盛顿州（1999 - 2009年，n = 76208）监狱释放人员回顾性队列研究的数据，并将每个队列的标识符与其各自国家的死亡指数相链接。我们估计了与传染病相关的死亡率（社区中每人年的死亡数），并使用Cox比例风险模型检验关联。
在澳大利亚队列中，监狱释放后与传染病相关的最常见潜在死因是肺炎（43%，23/54例死亡），在美国队列中是病毒性肝炎（40%，69/171例死亡）。美国队列中与传染病相关的死亡率显著高于澳大利亚队列（每10万人年51.2例死亡对26.5例死亡；发病率比 = 1.93，95%置信区间1.42，2.62）。在两个队列中，年龄增长都与传染病死亡率密切相关。
监狱释放人员中与传染病相关的死亡率的流行病学差异可能反映了每个地区社区卫生服务提供模式的差异。这些发现凸显了在从监狱过渡到社区期间预防和治疗丙型肝炎及其他传染病的重要性。
