Clinical Risk Factors for Death After Release from Prison in Washington State

While mortality rates after prison release are high, little is known about clinical risk factors for death. We sought to identify risk and protective factors for all-cause and accidental poisoning (overdose) death.

Nested case control study of people released from prison.

Washington State Department of Corrections, Washington, USA.

Cases (699 all-cause deaths, of which 88 were among women, and 206 additional overdose deaths, of which 76 were among women) between 1999 and 2009 matched 1:1 to controls on sex, age and year of release using risk set sampling.

Prison medical charts were abstracted for clinical information. Independent associations between clinical characteristics and all-cause and overdose mortality were assessed using conditional logistic regression.

Key independent risk factors for all-cause mortality included 

• homelessness, 
• injection drug use, 
• tobacco use, 
• cirrhosis, and 
• psychiatric medications before release. 

Independent risk factors for overdose mortality included 

• substance dependence, 
• injection drug use, 
• panic disorder, 
• psychiatric prescriptions before release, and 
• problems with opiates/sedatives. 

Substance use disorder treatment during the index incarceration was protective for all-cause and overdose  mortality.

Injection drug use and substance use disorders are risk factors for death after release from prison. In-prison substance use treatment services may reduce the risk. 

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By: Binswanger IA1,2,3, Stern MF4, Yamashita TE5, Mueller SR1,2, Baggett TP6,7, Blatchford PJ8.

• 1Kaiser Permanente Colorado, Institute for Health Research, Denver, USA.
• 2Division of General Internal Medicine, Department of Medicine and Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA.
• 3Denver Health Medical Center, Denver, USA.
• 4University of Washington School of Public Health, Department of Health Services, H664 Health Sciences Center, Seattle, USA.
• 5Undergraduate Medical Education, School of Medicine, University of Colorado Denver, Aurora, USA.
• 6Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
• 7Boston Health Care for the Homeless Program, Boston, MA, USA.
• 8Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.  

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