Center for Health Equity Research, University of North Carolina at Chapel Hill.
Department of Social Medicine, University of North Carolina at Chapel Hill.
JAMA Netw Open. 2019 Oct 2;2(10):e1912516. doi: 10.1001/jamanetworkopen.2019.12516.
Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes.
To characterize the association of restrictive housing with reincarceration and mortality after release.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019.
Restrictive housing during incarceration.
Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration.
From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34).
This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.
监禁期间的限制居住，也称为单独监禁，与健康状况不佳有关。
描述限制居住与释放后再监禁和死亡之间的关联。
设计、地点和参与者：这项回顾性队列研究包括 229274 名从 2000 年 1 月至 2015 年 12 月从北卡罗来纳州监狱系统获释的囚犯。监禁数据与 2000 年 1 月至 2016 年 12 月的死亡记录相匹配。协变量包括年龄、先前监禁次数、定罪类型、建议或接受的心理健康治疗、最近一次刑期内的服刑天数、性别和种族。数据分析于 2018 年 8 月至 2019 年 5 月进行。
监禁期间的限制居住。
死亡率（全因、阿片类药物过量、凶杀和自杀）和再监禁。
2000 年至 2015 年间，229274 人（197656[86.2%]名男性；92677[40.4%]名白人；中位数[四分位间距（IQR）]年龄，32 岁[26-42]）从北卡罗来纳州州立监狱系统中获释 398158 次。在限制居住的人群中，年龄中位数（IQR）为 30（24-38）岁，刑期中位数（IQR）为 382（180-1010）天；84272（90.3%）为男性，59482（63.7%）为非白人。在 387913 次监禁中的 130551 次监禁中（33.7%），有人被安置在限制居住中。与未被监禁和未被安置在限制居住中的囚犯相比，在限制居住中度过任何时间的囚犯在获释后的第一年死亡的风险更高（风险比[HR]，1.24；95%CI，1.12-1.38），尤其是自杀（HR，1.78；95%CI，1.19-2.67）和凶杀（HR，1.54；95%CI，1.24-1.91）。他们在释放后两周内死于阿片类药物过量的风险也更高（HR，2.27；95%CI，1.16-4.43），再入狱的风险也更高（HR，2.16；95%CI，1.99-2.34）。
这项研究表明，接触限制居住与社区重新融入期间死亡风险增加有关。这些发现对于正在进行的关于限制居住危害的辩论很重要，表明需要找到替代限制居住的方法，并将限制居住作为社区重新融入期间的一个重要风险因素。
