![]() Following release from prison, mortality was markedly elevated for men (IRR = 3.0 95% CI: 2.8 to 3.1) and women (IRR = 2.4 95% CI: 2.1 to 2.9). Incarcerated women experienced increased mortality from suicide (IRR = 6.0, 95% CI: 1.2 to 17.7) and communicable diseases (IRR = 2.5, 95% CI: 1.1 to 5.0). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4 95% confidence interval : 2.0 to 2.8), police stations (3.1 95% CI: 2.5 to 3.9), and youth detention (8.1 95% CI: 5.9 to 10.8). ![]() Deaths in custody were 2.2 times the number reported by the national prison administration ( n = 317). We additionally modeled mortality rates over time during and after incarceration for all causes of death, violence, or suicide. We analyzed age-standardized, all-cause, and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. Between Januand December 31, 2018, we identified 3,127 deaths of individuals with recent incarceration (705 in detention and 2,422 following release). We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a retrospective cohort of 114,751 individuals with recent incarceration. In Brazil, insufficient data have precluded our understanding of all-cause and cause-specific mortality during and after incarceration. The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. Mortality during and after incarceration is poorly understood in low- and middle-income countries (LMICs). Despite some indication of a reduction in excess mortality in recent years, there remains an overwhelming need for enhanced responses to mental health and drug problems for people who have been in prison. In the largest study so far reported, mortality of male and female offenders was far greater than expected for all major causes, especially deaths caused by drug overdose. Over the study period on average all-cause SMR decreased significantly in men (p = 0.003) and women (p = 0.05) largely due to the decline in SMRs for drug-related deaths and suicide. Aboriginal men were 4.8 times, and Aboriginal women 12.6 times, more likely to die than the general NSW population. We identified 5137 deaths (4714 men, 423 women) among the cohort of which the vast majority (4834, 94%) occurred following release from custody. The median overall follow-up of the cohort was 7.7 years. Time trends in SMRs were assessed using the test for linear trends. SMRs were calculated using sex, age, and calendar-specific death rates from the NSW population. Mortality rates were estimated using the person-time method. ![]() We obtained information on deaths by record linkage with the Australian National Death Index (NDI). ![]() Design: A retrospective cohort study of 85,203 adults imprisoned in New South Wales (NSW), Australia, between 1 January 1988 and 31 December 2002. Describe the standardized mortality ratio (SMR) and its trend in adults who have served time in prison.
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