Clinical risk factors for death after release from prison in Washington State: a nested case-control study
Clinical risk factors for death after release from prison in Washington State: a nested case-control study
复制标题
DOI：
10.1111/add.13200
复制
发表时间：
2016-03-01
期刊：
影响因子：
6
通讯作者：
Blatchford, Patrick J.
中科院分区：
文献类型：
--
作者：
Binswanger, Ingrid A.;Stern, Marc F.;Blatchford, Patrick J.
背景和目的虽然出狱后的死亡率很高，但人们对死亡的临床危险因素知之甚少。我们试图确定全原因和意外中毒(过量)死亡的风险和保护因素。设计针对出狱人员的嵌套病例对照研究。背景设在美国华盛顿华盛顿州惩教部。参与者1999至2009年间的病例(699例全原因死亡，其中88例为女性，196例额外的过量死亡，其中76例为女性)采用风险集抽样，在性别、年龄和释放年份方面与对照1：1匹配。全因死亡的独立危险因素包括无家可归[优势比(OR)=1.53，95%可信区间(CI)=1.06，2.23]，注射吸毒(OR=1.54，95%CI=1.16，2.06)，吸烟(OR=1.51，95%CI=1.07，2.13)，肝硬变(OR=4.42，95%CI=1.63，11.98)和出院前服用精神药物(OR=2.38，95%CI=1.71，3.30)。药物使用障碍(OR=2.33，95%CI=1.32，4.11)、注射吸毒(OR=2.43，95%CI=1.53，3.86)、惊恐障碍(OR=3.87，95%CI=1.62，9.21)、出院前精神药物处方(OR=2.44，95%CI=1.55，3.85)和阿片类/镇静剂问题(OR=2.81，95%CI=1.40，5.63)是过量死亡的独立危险因素。服刑期间药物使用障碍治疗对全因(OR=0.67，95%CI=0.49，0.91)和服药过量(OR=0.57，95%CI=0.36，0.90)死亡率具有保护作用。结论注射毒品和药物使用障碍是出狱后死亡的危险因素。监狱内的物质使用障碍治疗服务可能会降低风险。
Background and aimsWhile 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.DesignNested case-control study of people released from prison.SettingWashington State Department of Corrections, Washington, USA.ParticipantsCases (699 all-cause deaths, of which 88 were among women, and 196 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.MeasurementsPrison medical charts were abstracted for clinical information. Independent associations between clinical characteristics and all-cause and overdose mortality were assessed using conditional logistic regression.FindingsKey independent risk factors for all-cause mortality included homelessness [odds ratio (OR)=1.53, 95% confidence interval (CI)=1.06, 2.23], injection drug use (OR=1.54, 95% CI=1.16, 2.06), tobacco use (OR=1.51, 95% CI=1.07, 2.13), cirrhosis (OR=4.42, 95% CI=1.63, 11.98) and psychiatric medications before release (OR=2.38, 95% CI=1.71, 3.30). Independent risk factors for overdose mortality included substance use disorder (OR=2.33, 95% CI=1.32, 4.11), injection drug use (OR=2.43, 95% CI=1.53, 3.86), panic disorder (OR=3.87, 95% CI=1.62, 9.21), psychiatric prescriptions before release (OR=2.44, 95% CI=1.55, 3.85) and problems with opiates/sedatives (OR=2.81, 95% CI=1.40, 5.63). Substance use disorder treatment during the index incarceration was protective for all-cause (OR=0.67, 95% CI=0.49, 0.91) and overdose (OR=0.57, 95% CI=0.36, 0.90) mortality.ConclusionsInjection drug use and substance use disorders are risk factors for death after release from prison. In-prison substance use disorder treatment services may reduce the risk.