title: Clinical risk factors for death after release from prison in Washington State: a nested case-control study.
abstract: OBJECTIVE
  While 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.
  
  
  METHODS
  Nested case-control study of people released from prison.
  
  
  METHODS
  Washington State Department of Corrections, Washington, USA.
  
  
  METHODS
  Cases (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.
  
  
  METHODS
  Prison medical charts were abstracted for clinical information. Independent associations between clinical characteristics and all-cause and overdose mortality were assessed using conditional logistic regression.
  
  
  RESULTS
  Key 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.
  
  
  CONCLUSIONS
  Injection 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.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.forename: Marc F
authors.initials: MF
authors.lastname: Stern
authors.forename: Traci E
authors.initials: TE
authors.lastname: Yamashita
authors.forename: Shane R
authors.initials: SR
authors.lastname: Mueller
authors.forename: Travis P
authors.initials: TP
authors.lastname: Baggett
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blatchford
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons; D065840:Protective Factors; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012307:Risk Factors; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014861:Washington / Q000453:epidemiology
chemical_list: D011619:Psychotropic Drugs