Design, participants and setting: Application of crude mortality rates for ex-prisoners (obtained from two independent, state-based record-linkage studies [New South Wales and Western Australia]) to a national estimate of the number and characteristics of people released from prison in 2007–08.
Main outcome measures: Estimated number of deaths among adults released from Australian prisons in 2007–08, within 4 weeks and 1 year of release, classified by age, sex, Indigenous status and cause of death.
Results: It was estimated that among people released from prison in 2007–08, between 449 (95% CI, 380–527) and 472 (95% CI, 438–507) died within 1 year of release. Of these, between 68 (95% CI, 56–82) and 138 (95% CI, 101–183) died within 4 weeks of release. Most of these deaths were not drug-related.
Conclusion: The estimated annual number of deaths among recently released prisoners in Australia is considerably greater than the annual number of deaths in custody, highlighting the extreme vulnerability of this population on return to the community. There is an urgent need to establish a national system for routine monitoring of ex-prisoner mortality and to continue the duty of care beyond the prison walls.
- 1. Australian Bureau of Statistics. Prisoners in Australia, 2010. Canberra: ABS, 2010. (ABS Cat. No. 4517.0.)
- 2. Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: summary of results. Canberra: ABS, 2008. (ABS Cat. No. 4326.0.)
- 3. Martire KA, Larney S. Inadequate data collection prevents health planning for released prisoners [letter]. Med J Aust 2009; 191: 408-409. <MJA full text>
- 4. Krieg AS. Aboriginal incarceration: health and social impacts. Med J Aust 2006; 184: 534-536. <MJA full text>
- 5. Levy M. Australian prisons are still health risks [editorial]. Med J Aust 1999; 171: 7-8. <MJA full text>
- 6. Butler T, Andrews G, Allnutt S, et al. Mental disorders in Australian prisoners: a comparison with a community sample. Aust N Z J Psychiatry 2006; 40: 272-276.
- 7. Butler T, Kariminia A, Levy M, Murphy M. The self-reported health status of prisoners in New South Wales. Aust N Z J Public Health 2004; 28: 344-350.
- 8. Kinner SA. Continuity of health impairment and substance misuse among adult prisoners in Queensland, Australia. Int J Prisoner Health 2006; 2: 101-113.
- 9. Kinner SA, George J, Campbell G, Degenhardt L. Crime, drugs and distress: patterns of drug use and harm among criminally involved injecting drug users in Australia. Aust N Z J Public Health 2009; 33: 223-227.
- 10. Stewart L, Henderson C, Hobbs MST, et al. Risk of death in prisoners after release from jail. Aust N Z J Public Health 2004; 28: 32-36.
- 11. Kariminia A, Butler TG, Corben SP, et al. Extreme cause specific mortality in a cohort of adult prisoners — 1998 to 2002: a data-linkage study. Int J Epidemiol 2007; 36: 310-318.
- 12. Coffey C, Veit F, Wolfe R, et al. Mortality in young offenders: retrospective cohort study. BMJ 2003; 326: 1064.
- 13. Karaminia A, Law MG, Butler TG, et al. Suicide risk among recently released prisoners in New South Wales, Australia. Med J Aust 2007; 187: 387-390. <MJA full text>
- 14. Borzycki M. Interventions for prisoners returning to the community. Canberra: Attorney-General’s Department, 2005.
- 15. Degenhardt L, Day C, Dietze P, et al. Effects of a sustained heroin shortage in three Australian States. Addiction 2005; 100: 908-920.
- 16. Australian Institute of Health and Welfare. The health of Australia’s prisoners 2009. Canberra: AIHW, 2010. (AIHW Cat. No. PHE 123.)
- 17. Kinner SA. Understanding mortality and health outcomes for ex-prisoners: first steps on a long road. Addiction 2010; 105: 1555-1556.
- 18. Australian Bureau of Statistics. Prisoners in Australia, 2008. Canberra: ABS, 2008. (ABS Cat. No. 4517.0.)
- 19. Australian Bureau of Statistics. Corrective Services, Australia, Sep 2009. Canberra: ABS, 2009. (ABS Cat. No. 4512.0.)
- 20. Randall D, Roxburgh A, Gibson A, Degenhardt L. Mortality among people who use illicit drugs: a toolkit for classifying major causes of death. Sydney: National Drug and Alcohol Research Centre, University of NSW, 2009.
- 21. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison — a high risk of death for former inmates. N Engl J Med 2007; 356: 157-165.
- 22. Farrell M, Marsden J. Acute risk of drug-related death among newly released prisoners in England and Wales. Addiction 2008; 103: 251-255.
- 23. Bird SM, Hutchinson SJ. Male drugs-related deaths in the fortnight after release from prison: Scotland, 1996–99. Addiction 2003; 98: 185-190.
- 24. Merrall ELC, Kariminia A, Binswanger IA, et al. Meta-analysis of drug-related deaths soon after release from prison. Addiction 2010; 105: 1545-1554.
- 25. Degenhardt L, Rendle V, Hall W, et al. Estimating the number of current regular heroin users in NSW and Australia 1997–2002. NDARC Technical Report. Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2004.
- 26. Kariminia A, Law MG, Butler TG, et al. Factors associated with mortality in a cohort of Australian prisoners. Eur J Epidemiol 2007; 22: 417-428.
- 27. Hobbs M, Krazlan K, Ridout S, et al. Mortality and morbidity in prisoners after release from prison in Western Australia 1995–2003. Research and Public Policy Series no. 71. Canberra: Australian Institute of Criminology, 2006.
- 28. Dolan KA, Shearer J, White B, et al. Four-year follow-up of imprisoned male heroin users and methadone treatment: mortality, re-incarceration and hepatitis C infection. Addiction 2005; 100: 820-828.
- 29. Ministerial Council on Drug Strategy. National Corrections Drug Strategy 2006–2009. Canberra: MCDS, 2008.
- 30. Kim D, Irwin KS, Khoshnood K. Expanded access to naloxone: options for critical response to the epidemic of opioid overdose mortality. Am J Public Health 2009; 99: 402-407.
- 31. Lenton SR, Dietze PM, Degenhardt L, et al. Naloxone for administration by peers in cases of heroin overdose. Med J Aust 2009; 191: 469. <MJA full text>
- 32. Royal Commission into Aboriginal Deaths in Custody. National report. Canberra: Australian Government Publishing Service, 1991.
- 33. Curnow J, Larsen JJ. Deaths in custody in Australia: National Deaths in Custody Program 2007. Monitoring report no. 3. Canberra: Australian Institute of Criminology, 2009.
- 34. Sibthorpe B, Kliewer E, Smith L. Record linkage in Australian epidemiological research: health benefits, privacy safeguards and future potential. Aust J Public Health 1995; 19: 250-256.
- 35. Brook EL, Rosman DL, Holman CDAJ. Public good through data linkage: measuring research outputs from the Western Australian Data Linkage System. Aust N Z J Public Health 2008; 32: 19-23.
- 36. Forsyth S, Kinner SA, Williams G, et al. Post-release mortality among ex-prisoners in Queensland: a data linkage study. Proceedings of Public Health Association Australia Justice Health Conference. Justice health in Australia: beyond the convict era; 2009 Apr 6-7; Melbourne, Australia.
- 37. Hulse GK, English DR, Milne E, Holman CDJ. The quantification of mortality resulting from the regular use of illicit opiates. Addiction 1999; 94: 221-229.
- 38. Hall WD, Ross JE, Lynskey MT, et al. How many dependent heroin users are there in Australia? Med J Aust 2000; 173: 528-531. <MJA full text>
- 39. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003; 362: 847-852.
- 40. Clark A, Preen DB, Ng JQ, et al. Is Western Australia representative of other Australian states and territories in terms of key socio-demographic and health economic indicators? Aust Health Rev 2010; 34: 210-215.
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