title: A comparison of liver disease mortality with HIV and overdose mortality among Georgia prisoners and releasees: a 2-decade cohort study of prisoners incarcerated in 1991.
abstract: OBJECTIVE
  We investigated whether eventual causes of death among a cohort of inmates imprisoned in the southeastern United States differed from those in previous prisoner studies.
  
  
  METHODS
  We matched 23 510 prisoners in Georgia, a state with historically low levels of heroin consumption but moderate amounts of injection drug use, who were incarcerated on June 30, 1991, to death registries through 2010. Main exposure was 4-year time intervals over 2 decades of observation; main outcome was mortality from liver disease, HIV, and overdose.
  
  
  RESULTS
  Although the HIV-related mortality rate exceeded that from liver-related conditions before 2003, liver disease subsequently surpassed HIV as a cause of death. Among 3863 deaths, 22 (0.6%) occurred within 2 weeks after release from prison. Of these, only 2 were caused by accidental poisoning (likely drug overdose). Cardiovascular disease and cancer were the most frequent causes of death in this aging cohort.
  
  
  CONCLUSIONS
  Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast.
authors: At the time of the study, Anne C. Spaulding, Lauren C. Messina, and Maria Zlotorzynska were with and Akshay Sharma was a doctoral student in the Department of Epidemiology, Rollins School of Public Health, and Lesley Miller was with the Division of General Medicine, School of Medicine, Emory University, Atlanta, GA. Ingrid A. Binswanger is with the University of Colorado School of Medicine, Aurora.
authors: Anne C
authors: AC
authors: Spaulding
authors: Akshay
authors: A
authors: Sharma
authors: Lauren C
authors: LC
authors: Messina
authors: Maria
authors: M
authors: Zlotorzynska
authors: Lesley
authors: L
authors: Miller
authors: Ingrid A
authors: IA
authors: Binswanger
mesh_terms: D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000401:mortality*; D006556:Heroin Dependence / Q000401:mortality*; D006801:Humans; D008107:Liver Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult