Mortality over 12 years of follow-up in people admitted to provincial custody in Ontario: a retrospective cohort study

Abstract

Background:We aimed to define rates and causes of death in custody and after release in people admitted to provincial custody in Ontario, and to compare these data with data for the general population. Methods:We linked data on adults admitted to provincial custody in Ontario in 2000 with data on deaths between 2000 and 2012. We examined rates and causes of death by age, sex, custodial status and period after release, and compared them with data for the general population, using indirect adjustment for age.Results: Between 2000 and 2012, 8.6% (95% confidence interval [CI] 8.3%-8.8%) of those incarcerated died in provincial custody or after release. The crude death rate was 7.1 (95% CI 6.9-7.3) per 1000 person-years. The standardized mortality ratio for those incarcerated in 2000 was 4.0 (95% CI 3.9-4.1) overall and 1.9 (95% CI 1.5-2.4) while in provincial custody. The most common causes of death were injury and poisoning (38.2% of all deaths), including overdose (13.6%) and suicide (8.2%), diseases of the circulatory system (15.8%) and neoplasms (14.5%). In the 2 weeks after release, the standardized mortality ratio was 5.7 overall and 56.0 for overdose. Life expectancy was 72.3 years for women and 73.4 for men who experienced incarceration in 2000. Interpretation:Mortality was high for people who experienced incarceration, and life expectancy was 4.2 years less for men and 10.6 years less for women compared with the general population. Efforts should be made to reduce the gap in mortality between people who experience incarceration and those who do not. Time in custody could serve as an opportunity to intervene to decrease risk. Abstract Research CMAJ OPEN E154CMAJ OPEN, 4(2) sentenced) or incarcerated (i.e., sentenced); in this article we use the term incarcerated to represent both of these groups.

Overincarceration of Indigenous people: a health crisis

“…5 Yet, even these estimates of years of life lost to incarceration do not account for the years of life lost resulting from health effects of incarceration.Incarceration has wide-ranging consequences for human health: from direct to indirect; from infections to death; and from individual-to family-and population-level effects.After individuals are released from incarceration, their risk of death is substantially higher than the average risk of death in the community. 2,6 This risk is particularly high in the first 2 weeks after release -with a reported increase of 6 times the expected number of deaths after accounting for age and sex 2 -largely attributable to drug overdose (56 times the average risk in the 2 weeks after release) 2 and suicide (29 times the average risk between 2 and 4 weeks after release). 2 The risk of death after release from incarceration also increases the longer the person is incarcerated.…”

“…1 It is well known that incarceration is a negative determinant of health. 2 For Indigenous Peoples, the legacy of colonialism and ongoing systemic racism, including in the Canadian justice system, 3 has both immediate and far-reaching negative health impacts, and contributes to health inequities between Indigenous and non-Indigenous Peoples. The overincarceration of Indigenous people leads to an inequitable distribution of the health harms of incarceration, as well as an enormous burden of years of life lost attributable to incarceration for Indigenous Peoples.…”

Canadian Institutes of Health Research funding of prison health research: a descriptive study

“…2 Research from Canada and other countries shows that the health of people who experience incarceration is substantially worse than the health of the general population with respect to social determinants of health, mental illness, substance use, mortality, communicable diseases, and intentional and unintentional injuries. [3][4][5] There is growing evidence for strategies to improve the health of this population while in custody and after release to the community, 6 although many of these interventions have not been implemented in Canada. Improving the health of this population could reduce health inequity, contribute to public health through lower transmission of communicable diseases, improve public safety through the treatment of substance use disorders and mental illness, and lower costs of reincarceration and inappropriate health care use.…”

Editorial - Reducing premature mortality among young and middle-aged adults

“…15 Of those who experience incarceration within a Canadian provincial correctional facility, the standardized mortality ratio is 4.0 (95% CI: 3.9-4.1), with injury and poisoning accounting for 38% of all deaths, 16 and the most pronounced RRs among the youngest offenders, especially women. 16 We see similar statistics for those in a Canadian federal correctional facility. 17 Thus, it is apparent that some adults prone to premature death are caught in a web of mental illness, substance use and criminality, often starting from youth.…”