British Columbia Centre for Disease Control, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Addiction. 2021 Jun;116(6):1460-1471. doi: 10.1111/add.15293. Epub 2020 Nov 27.
Reported associations between previous incarceration and the risk of overdose-related death are substantially heterogeneous, and previous studies are limited by an inability to control for confounding factors in risk assessment. This study investigated the associations of overdose-related death with previous incarceration and the number or cumulative duration of previous incarcerations, and individual or neighborhood characteristics that may potentially modify the associations.
A cohort study using a 20% random sample of residents in British Columbia, Canada.
A total of 765 690 people aged 23 years or older at baseline as of 1 January 2015. Mean age was 50 years; 49% were males.
Previous incarcerations that occurred during the 5-year exposure period (January 2010 to December 2014) were identified using provincial incarceration records. Overdose-related deaths that occurred during the 3-year follow-up period (January 2015 to December 2017) were identified using linked administrative health data. Baseline individual and neighborhood characteristics were retrieved from the provincial health insurance data.
In the cohort, 5743 people had an incarceration history during the exposure period, and 634 people died from drug overdose during the follow-up period. The mortality rate was 897 and 22 per 100 000 person-years for people who did and did not have an incarceration history, respectively. After adjusting for baseline individual and neighborhood characteristics (without any interaction term), people who had an incarceration history were 4.04 times (95% confidence interval 3.23-5.06) more likely to die from drug overdose compared with people without an incarceration history. The association was stronger for females, people without diagnoses of substance use disorder and people without dispensation of opioids for pain or benzodiazepines (P < 0.001 for each interaction term). There was no discernible linear trend between the number or cumulative duration of previous incarcerations and the risk of overdose-related death.
Previous incarceration appears to be a major risk factor for overdose-related death.
先前被监禁与药物过量相关死亡风险之间的关联报告存在显著差异，而先前的研究受到无法在风险评估中控制混杂因素的限制。本研究调查了与药物过量相关的死亡与先前被监禁以及先前被监禁的次数或累计时间、可能改变关联的个体或社区特征之间的关联。
一项使用加拿大不列颠哥伦比亚省 20%随机抽样居民的队列研究。
截至 2015 年 1 月 1 日，基线时年龄在 23 岁或以上的共有 765690 人。平均年龄为 50 岁，49%为男性。
在 5 年暴露期（2010 年 1 月至 2014 年 12 月）期间，使用省级监禁记录确定了先前的监禁情况。在 3 年随访期（2015 年 1 月至 2017 年 12 月）期间，通过链接的行政健康数据确定了与药物过量相关的死亡情况。基线个体和社区特征从省级健康保险数据中检索。
在队列中，有 5743 人在暴露期内有监禁史，有 634 人在随访期内死于药物过量。监禁史人群的死亡率为 897 人/100000 人年，无监禁史人群的死亡率为 22 人/100000 人年。在调整了基线个体和社区特征（无任何交互项）后，有监禁史的人死于药物过量的可能性是没有监禁史的人的 4.04 倍（95%置信区间 3.23-5.06）。对于女性、没有物质使用障碍诊断和没有开阿片类药物或苯二氮䓬类药物用于疼痛的人，这种关联更强（对于每个交互项，P 值均<0.001）。先前被监禁的次数或累计时间与药物过量相关死亡风险之间没有明显的线性趋势。
先前被监禁似乎是药物过量相关死亡的一个主要危险因素。
