Extreme cause-specific mortality in a cohort of adult prisoners - 1988 to 2002: a data-linkage. study
Extreme cause-specific mortality in a cohort of adult prisoners - 1988 to 2002: a data-linkage. study
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DOI：
10.1093/ije/dyl225
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发表时间：
2007-04-01
影响因子：
7.7
通讯作者：
Law, M. G.
中科院分区：
文献类型：
--
作者：
Kariminia, A.;Butler, T. G.;Law, M. G.
目的：描述在监狱服刑的成年人的标准化死亡率（SMR）及其趋势。设计：对1988年1月1日至2002年12月31日在澳大利亚新南威尔士州监禁的85 203名成年人进行回顾性队列研究。方法：我们通过与澳大利亚国家死亡指数（NDI）的记录联系获得死亡信息。死亡率采用人次法估计。使用新南威尔士州人口的性别、年龄和日历特定死亡率来计算smr。使用线性趋势检验评估smr的时间趋势。结果：该队列的中位总随访时间为7.7年。我们在队列中确定了5137例死亡（4714名男性，423名女性），其中绝大多数（4834,94%）发生在释放后。男性全因SMR为3.7 (95% CI: 3.6-3.8)，女性为7.8 （95% CI: 7.1-8.5）。由于精神和行为障碍导致的死亡（男性：13.2,95% CI: 12.3-14.0；女性：62.8,95% CI: 52.7-74.9）和药物相关死亡（男性：12.8,95% CI: 12.2-13.5；女性：50.3,95% CI: 43.7-57.8）的smr大幅提高。男性凶杀死亡的SMR为10.2 (95% CI: 8.9-11.7)，女性为26.3 （95% CI: 17.8-39.0）。与新南威尔士州一般人口相比，土著男性的死亡率是4.8倍，土著女性是12.6倍。在研究期间，男性（p= 0.003）和女性（p= 0.05）的平均全因SMR显著下降，这主要是由于药物相关死亡和自杀的SMR下降。结论：在迄今为止报道的最大规模的研究中，男性和女性罪犯的死亡率远远高于所有主要原因的预期，特别是由药物过量引起的死亡。尽管近年来有一些迹象表明，过高的死亡率有所下降，但仍然迫切需要加强对服刑人员的精神健康和毒品问题的应对。
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.