Predicting death in young offenders: a retrospective cohort study.
OBJECTIVE
To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services.


METHODS
A retrospective cohort of 2849 (2625 male) 11-20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified.


METHODS
Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records.


RESULTS
The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0-1.9), repeat admissions (HR, 1.8; 95% CI, 1.1-2.9) and drug offences (HR, 1.5; 95% CI, 1.0-2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1-5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5-20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3-68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15-0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0-2.4).


CONCLUSIONS
Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to reduce the mortality rate in this group.
Coffey
Carolyn
C
Centre for Adolescent Health, Murdoch Children's Research Institute, 2 Gatehouse Street, Parkville, VIC 3052. carolyn.coffey@rch.org.au
Wolfe
Rory
R
Lovett
Andrew W
AW
Moran
Paul
P
Cini
Eileen
E
Patton
George C
GC
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001208:Asia / Q000208:ethnology; D002423:Cause of Death / Q000639:trends*; D002648:Child; D015331:Cohort Studies; D003644:Death Certificates; D005260:Female; D006801:Humans; D007604:Juvenile Delinquency / Q000639:trends*; D008297:Male; D020380:Needs Assessment; D010343:Patient Admission / Q000639:trends; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011329:Prisoners / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000639:trends; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality; D000095283:Australian Aboriginal and Torres Strait Islander Peoples