Background

Incarceration might contribute to increased mortality in an already marginalised population. A better understanding of the prison-related factors that are associated with mortality is important for preventing the negative health consequences of incarceration. We aimed to investigate all-cause and cause-specific mortality following release from high-security and low-security prisons.

Methods

In this retrospective national cohort study, we used data from the Norwegian Prison Release study (nPRIS), which includes complete national register data for 96 859 individuals from the Norwegian Prison Register linked to the Norwegian Cause of Death Register from Jan 1, 2000, to Dec 31, 2016. The study cohort included all people in Norway released from a high-security or low-security prison unit. Cause of death was categorised into internal causes (infectious, cancerous, endocrine, circulatory, respiratory, digestive, nervous system diseases, and mental health disorders) and external causes (accidents, suicides, and homicides) according to the 10th revision of the International Classification of Diseases. We calculated crude mortality rates (CMR) and estimated Cox proportional-hazards models.

Findings

There were 151 790 releases in the study period (68·4% from low-security and 31·6% from high-security prisons) from 91 963 individuals. The overall CMR was 854·4 [95% CI 834·7–874·2] per 100 000 person-years (436·2 [422·1–450·3] per 100 000 person-years for internal causes and 358·3 [345·5–371·1] per 100 000 person-years for external causes). The overall post-release mortality rate was higher in those released from high-security prisons (1142·5 [95% CI 1102·6–1182·5] per 100 000 person-years) than in those released from low-security prisons (714·6 [692·6–736·6] per 100 000 person-years). Our results suggest an association between release from high-security prisons and elevated mortality due to both external causes (adjusted hazard ratio [aHR] 1·75 [95% CI 1·60–1·91]) and internal causes (1·45 [1·33–1·59]), compared to release from low-security prisons.

Interpretation

Imprisonment and the post-release period can be an important point for public health interventions. Particular attention to health is warranted for individuals incarcerated in and released from high-security prisons. The potential impact of both individual-level characteristics of people incarcerated in high-security facilities, and of the prison environment itself, on mortality outcomes, should be investigated further.

Funding

The South-Eastern Norway Regional Health Authority and The Norwegian Research Council.

中文翻译：

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监狱安全水平与出狱后死亡率的关系：一项回顾性全国队列研究（2000-16）

背景

监禁可能会导致已经边缘化的人口死亡率增加。更好地了解与死亡率相关的监狱相关因素对于预防监禁对健康的负面影响非常重要。我们旨在调查从高安全性和低安全性监狱释放后的全因和特定原因死亡率。

方法

在这项回顾性国家队列研究中，我们使用了来自挪威监狱释放研究 (nPRIS) 的数据，其中包括 2000 年 1 月 1 日挪威监狱登记处与挪威死因登记处相关联的 96859 人的完整国家登记处数据， 2016 年 12 月 31 日。研究队列包括挪威所有从高安全性或低安全性监狱单位释放的人。根据国际分类第十次修订版，死因分为内因（传染性、癌症、内分泌、循环系统、呼吸系统、消化系统、神经系统疾病和精神疾病）和外因（事故、自杀和凶杀）。的疾病。我们计算了粗死亡率 (CMR) 和估计的 Cox 比例风险模型。

发现

在研究期间，共有 91 963 人释放了 151 790 人（68·4% 来自低安全监狱，31·6% 来自高度安全监狱）。总体 CMR 为每 10 万人年 854·4 [95% CI 834·7–874·2]（内部原因为每 10 万人年 436·2 [422·1–450·3] 和 358· 3 [345·5–371·1] 每 100 000 人年的外部原因）。从高度戒备监狱释放的人的总体释放后死亡率（每 10 万人年 1142·5 [95% CI 1102·6–1182·5]）高于从低安全监狱释放的人（ 714·6 [692·6–736·6] 每 10 万人年）。我们的研究结果表明，从高度安全的监狱中释放与由于外部原因（调整后的风险比 [aHR] 1·75 [95% CI 1·60–1·91]）和内部原因（1·45）导致的死亡率升高之间存在关联。 [1·33–1·59]),

解释

监禁和释放后时期可能是公共卫生干预的一个重点。对于在戒备森严的监狱中监禁和释放的个人，需要特别注意健康。应该进一步调查被关押在高度安全设施中的人的个人层面特征以及监狱环境本身对死亡率结果的潜在影响。

资金

挪威东南部地区卫生局和挪威研究委员会。