title: Risk factors for all-cause, overdose and early deaths after release from prison in Washington state.
abstract: BACKGROUND
  High mortality rates after release from prison have been well-documented, particularly from overdose. However, little is known about the risk factors for death after release from prison. Therefore, the objective of this study was to determine the demographic and incarceration-related risk factors for all-cause, overdose and early mortality after release from prison.
  
  
  METHODS
  We conducted a retrospective cohort study of inmates released from a state prison system from 1999 through 2003. The cohort included 30,237 who had a total of 38,809 releases from prison. Potential risk factors included gender, race/ethnicity, age, length of incarceration, and community supervision. Cox proportional hazards regression was used to determine risk factors for all-cause, overdose and early (within 30 days of release) death after release from prison.
  
  
  RESULTS
  Age over 50 was associated with an increased risk for all-cause mortality (hazard ratio [HR] 2.67 for each decade increase, 95% confidence interval [CI] 2.23, 3.20) but not for overdose deaths or early deaths. Latinos were at decreased risk of death compared to Whites only for all-cause mortality (HR 0.61, 95% CI 0.42, 0.87). Increasing years of incarceration were associated with a decreased risk of all-cause mortality (HR 0.95, 95% CI 0.91, 0.99) and overdose deaths (HR 0.80, 95% CI 0.68, 0.95), but not early deaths. Gender and type of release were not significantly associated with all-cause, overdose or early deaths.
  
  
  CONCLUSIONS
  Age, ethnicity and length of incarceration were associated with mortality after release from prison. Interventions to reduce mortality among former inmates are needed.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado Denver, Mailstop B180, Aurora, CO 80025, USA. ingrid.binswanger@ucdenver.edu
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blatchford
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Lindsay
authors.forename: Marc F
authors.initials: MF
authors.lastname: Stern
mesh_terms: D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D015331:Cohort Studies; D062787:Drug Overdose / Q000401:mortality*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D014861:Washington