Azar Kariminia

We examined factors associated with increased mortality in a cohort of 85,203 adults with a history of imprisonment in New South Wales, Australia, between 1988 and 2002. Information on death was collected through linkage to the Australian National Death Index. The influence of demographic and criminological factors on the standardised mortality ratio (SMR) for all-cause mortality, and deaths due to drug overdose and suicide was examined using negative binomial regression models. The number of deaths identified was 5,137 (4,714 men, 423 women, 303 in custody). The overall SMR was 3.7 (3.6–3.8) in men and 7.8 (7.1–8.5) in women. SMRs raised for deaths due to drug overdose (men: 12.8, women: 50.3) and suicide (men: 4.8, women: 12.2). The high SMR was associated with hospitalisation for mental illness, multiple imprisonments, and early stage of follow-up independently of causes of death. Being released from prison increased the SMRs for all-cause and drug-related mortality, but not suicide. For women, significant trends for decreasing risk with increasing age were noted. Minority groups, in particular men, had a lower risk of death than white people. In men a sex or drug offence was associated with a lower risk and a property or violence offence was related to higher mortality. Our results reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Certain demographic and imprisonment characteristics are indicators of high mortality among this population. The underlying causes of some of these characteristics such as mental illness or multiple imprisonments are potentially treatable and preventable. Prison health services need to develop interventions targeting high-risk groups to avoid this situation.

Objectives: Describe the standardized mortality ratio (SMR) and its trend in adults who have served time in prison. Design: A retrospective cohort study of 85 203 adults imprisoned in New South Wales (NSW), Australia, between 1 January 1988 and 31 December 2002. Methods: We obtained information on deaths by record linkage with the Australian National Death Index (NDI). Mortality rates were estimated using the person-time method. SMRs were calculated using sex, age, and calendar-specific death rates from the NSW population. Time trends in SMRs were assessed using the test for linear trends. Results: The median overall follow-up of the cohort was 7.7 years. We identified 5137 deaths (4714 men, 423 women) among the cohort of which the vast majority (4834, 94%) occurred following release from custody. All-cause SMR was 3.7 (95% CI: 3.6–3.8) in men and 7.8 (95% CI: 7.1–8.5) in women. SMRs were substantially raised for deaths due to mental and behavioural disorders (men: 13.2, 95% CI: 12.3–14.0; women: 62.8, 95% CI: 52.7–74.9) and drug-related deaths (men: 12.8, 95% CI: 12.2–13.5; women: 50.3, 95% CI: 43.7–57.8). The SMR for death by homicide was 10.2 (95% CI: 8.9–11.7) in men and 26.3 (95% CI: 17.8–39.0) in women. Aboriginal men were 4.8 times, and Aboriginal women 12.6 times, more likely to die than the general NSW population. Over the study period on average all-cause SMR decreased significantly in men (p = 0.003) and women (p = 0.05) largely due to the decline in SMRs for drug-related deaths and suicide. Conclusion: In the largest study so far reported, mortality of male and female offenders was far greater than expected for all major causes, especially deaths caused by drug overdose. Despite some indication of a reduction in excess mortality in recent years, there remains an overwhelming need for enhanced responses to mental health and drug problems for people who have been in prison.

Issue addressed To describe the incidence and patterns of injuries sustained by inmates at two correctional centres in New South Wales, Australia. Methods A prospective study monitoring clinic presentations for injuries between July and December 2002. Nurses located within the clinics recorded injuries on a surveillance form and subsequently entered the data into a centralised database. Results During the study period, there were 160 new injury presentations to the two prison clinics; 109 were for accidental injuries and 50 for injuries resulting from violence. The most common types of injuries among prisoners were sports (32.5) and assaults (24.4). Sprains and strains were the most common types of sports injuries. Assaults occurred in similar proportions in both violent and non-violent offenders (26% vs. 24%, p=0.9) and were more common on Sundays. Most injuries (28%) occurred in the prison yard. Seventeen per cent of all injuries happened in the workplace with 63% caused by machinery. Workplace machinery accounted for half of all eye injuries. Analysis of the text descriptions identified that welding flash was responsible for 82% of all eye injuries. So what? Injury surveillance based on clinic presentations in the correctional setting is feasible and has potential to be used for the development of prison-specific prevention programs. Surveillance is also valuable in describing the dynamics of the prison environment.