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Predicting death in young offenders: a retrospective cohort study

Carolyn Coffey, Andrew W Lovett, Eileen Cini, George C Patton, Rory Wolfe and Paul Moran
Med J Aust 2004; 181 (9): 473-477.

Summary

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

Design: 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.

Main outcome measures: 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.

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  • Carolyn Coffey1
  • Andrew W Lovett2
  • Eileen Cini3
  • George C Patton4
  • Rory Wolfe5
  • Paul Moran6

  • 1 Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, VIC.
  • 2 Department of Epidemiology and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC.
  • 3 Health Services Research Department, Institute of Psychiatry, London, UK.

Correspondence: 

Acknowledgements: 

This study was funded by the National Health and Medical Research Council through the Competing Standard Project Grant 105422; the NHMRC had no role in study design, conduct or interpretation. We would like to thank Professor Ian Anderson for his comments on the article.

Competing interests:

None identified.

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