摘要：Objectives. We compared mortality of ex-prisoners and other state residents to identify unmet health care needs among former prisoners. Methods. We linked North Carolina prison records with state death records for 1980 to 2005 to estimate the number of overall and cause-specific deaths among male ex-prisoners aged 20 to 69 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the number of expected deaths had they experienced the same age-, race-, and cause-specific death rates as other state residents. Results. All-cause mortality among White (SMR = 2.08; 95% confidence interval [CI] = 2.04, 2.13) and Black (SMR = 1.03; 95% CI = 1.01, 1.05) ex-prisoners was greater than for other male NC residents. Ex-prisoners' deaths from homicide, accidents, substance use, HIV, liver disease, and liver cancer were greater than the expected number of deaths estimated using death rates among other NC residents. Deaths from cardiovascular disease, lung cancer, respiratory diseases, and diabetes were at least 30% greater than expected for White ex-prisoners, but less than expected for Black ex-prisoners. Conclusions. Ex-prisoners experienced more deaths than would have been expected among other NC residents. Excess deaths from injuries and medical conditions common to prison populations highlight ex-prisoners' medical vulnerability and the need to improve correctional and community preventive health services. The United States has the highest incarceration rate in the world, 1 but 95% of prisoners are eventually released, 2 with most reentering society after less than 2 years of imprisonment. 3 The result is a large and ever-increasing population of former inmates. 4 This growing population shoulders a heavy burden of disease, particularly infectious diseases such as hepatitis C virus, HIV, and other sexually transmitted infections. 5 This burden is a reflection of high disease rates in the impoverished communities from which prisoners come and prisoners' engagement in behaviors that are both illegal and harmful to health. 6 Mental health conditions, including substance use disorders, are also common among prisoners. 7 , 8 These conditions are not only directly harmful, they also may exacerbate other comorbidities (e.g., cardiovascular disease and diabetes) 9 , 10 and are associated with diminished access to routine medical care. 11 , 12 The transition from prison back into the community is typically difficult. Ex-prisoners often need to seek out housing and employment, reestablish personal relationships, navigate access to supportive services, and abide by the restrictions of parole and other legal sanctions. 13 These needs frequently supersede routine health care. 14 For some, the transition is also dangerous. For ex-prisoners, risk of death in the first year—and especially in the first few weeks—after release is high compared with the risk of death among the general population. 15 – 18 The vast majority of these deaths are the result of nonnatural causes, particularly homicide, suicide, and drug overdose. 15 – 18 In one of the few US studies of its kind, risk of death among former Washington state prisoners during the first 2 weeks after release was 12.7 times the risk of death among other state residents, and risk of death from drug overdose during the first 2 weeks after release was 129 times that of other state residents. 18 Even less well-studied in the United States are the long-term health outcomes of former prisoners. A large retrospective study conducted in Australia reported that mortality among prisoners exceeded that of the general population across all major causes of death. 19 The public health implication of these findings for the United States is troubling given the large size of the US ex-prisoner population, the heavy burden of disease among prisoners, and the legal sanctions and social stigma that diminish access to resources after release from prison. The purpose of our study was to examine the mortality of prisoners after their release. Specifically, we used age-standardized mortality ratios stratified by race to examine overall and cause-specific mortality among male former inmates. In addition, we examined the relative risk of mortality among former prisoners after we controlled for a measure of socioeconomic status (SES) and assessed time between prison release and death from injuries common to former prisoners. Enumeration of mortality disparities among former inmates could help detect lapses in the continuity between correctional and community health care resources.
