title: Aboriginal and non-aboriginal Australian former prisoners' patterns of morbidity and risk of hospitalisation.
abstract: People who have been in custody are more likely to experience multiple, long standing health issues. They are at high risk of illness and injury post release and experience poor access to health services both of which contribute to high rates of recidivism. The study was conducted to examine Aboriginal and non-Aboriginal former prisoners' risk of hospitalisation and rehospitalisation in the five years post release from custody and identified the common reasons for hospitalisations.
  
  
  
  Common reasons for hospital admission were identified by conducting descriptive analysis of linked data, related to former prisoners, from NSW Ministry of Health and Corrective Services NSW. This relied upon admitted patient data for 1899 patients. Of this cohort, 1075 people had been admitted to hospital at least once and remained out of custody over a five year period. The independent variables we studied included age, sex, and whether or not the person was Aboriginal. We conducted univariate and multivariate analysis on the following dependent variables: number of admissions over five years after release; more than one admission; days between custody and first hospitalisation; and days between first and second hospitalisation.
  
  
  
  Mental and behavioural disorders, injuries and poisoning, and infectious or parasitic diseases were the three most common reasons for admission. Aboriginal and non-Aboriginal former prisoners had a broadly similar pattern of reasons for admission. Yet Aboriginal former prisoners were more likely than non-Aboriginal former prisoners to have a shorter mean interval between hospital admission and readmission (187 days compared to 259 days, t = 2.90, p-0.004).
  
  
  
  Despite poorer health among Aboriginal people, there were broadly similar patterns of reasons for admission to hospital among Aboriginal and non-Aboriginal former prisoners. There may be a number of explanations for this. The cohort was not a representative sample of the NSW prison population. There was an overrepresentation of individuals with cognitive disability (intellectual disability, acquired brain injury, dementia, fetal alcohol spectrum disorder) in the study population, which may have impacted on this group accessing hospital health care. Alternatively perhaps there were fewer presentations to hospital by Aboriginal former prisoners despite a greater need. The shorter interval between hospital admission and readmission for Aboriginal former prisoners may suggest the need for better follow up care in the community after discharge from hospital. This presents an opportunity for primary health care services to work more closely with hospitals to identify and manage Aboriginal former prisoners discharged from hospital so as to prevent readmission.
authors.affiliation: Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, Australia. j.lloyd@unsw.edu.au.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Lloyd
authors.affiliation: School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McEntyre
authors.affiliation: School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Eileen
authors.initials: E
authors.lastname: Baldry
authors.affiliation: School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Julian
authors.initials: J
authors.lastname: Trofimovos
authors.affiliation: School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Devon
authors.initials: D
authors.lastname: Indig
authors.affiliation: Department of General Practice, Faculty of Medicine, Western Sydney University, Sydney, Australia.
authors.forename: Penelope
authors.initials: P
authors.lastname: Abbott
authors.affiliation: Department of General Practice, Faculty of Medicine, Western Sydney University, Sydney, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reath
authors.affiliation: Aboriginal and Islander Health Worker Journal, Sydney, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Malera-Bandjalan
authors.affiliation: Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D000328:Adult; D001315:Australia; D003416:Criminal Law; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D007239:Infections; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D009017:Morbidity; D010272:Parasitic Diseases; D010359:Patient Readmission; D011041:Poisoning; D011329:Prisoners; D011330:Prisons; D012306:Risk; D014947:Wounds and Injuries; D055815:Young Adult
keywords: Aboriginal Australians; Access to health care; Criminal justice; Hospitalisation