We followed 30,237 persons who had been released from the Washington State Department of Corrections for a total of 57,049 person-years (a total of 38,809 releases). The mean (±SD) age at release was 33.4±9.8 years (range, 18 to 84) (). The majority were non-Hispanic white (62%) and male (87%); 91% of those who reported that they were Hispanic also reported being white. The mean length of incarceration was 22.9±37.8 months; in many cases, incarceration had begun before the start of the study. Approximately a quarter of the study cohort was released more than once during follow-up (range, 1 to 10 releases).
Characteristics of 30,237 Persons Released from the Washington State Department of Corrections, July 1999–December 2003.
Over a mean follow-up period of 1.9±3.1 years, 443 persons included in the analysis died. Of these, 253 persons died within 1 year after release from prison. Of deaths reported according to state, 379 occurred in Washington, 17 in Oregon, 17 in California, 4 in Texas, 3 in Idaho, and the remainder elsewhere. Overall, the mortality rate among released inmates () was 777 deaths from all causes per 100,000 person-years (95% CI, 707 to 852). In contrast, the calculated mortality rate for Washington State residents of the same age, sex, and race as the former inmates was 223 deaths per 100,000 person-years. The mortality rate among former inmates was 3.5 times (95% CI, 3.2 to 3.8) that among state residents of the same age, sex, and race (). The attributable-risk percentage was 71%, amounting to 316 excess deaths.
Mortality Rates among Former Inmates of the Washington State Department of Corrections during the Study Follow-up (Overall) and According to 2-Week Periods after Release from Prison
Deaths and the Relative Risk (RR) of Death among Former Inmates of the Washington State Department of Corrections, as Compared with Other State Residents, Adjusted for Age, Sex, and Race.
During the first 2 weeks after release, the rate of death from all causes among former inmates was 2589 per 100,000 person-years (95% CI, 1884 to 3558). The adjusted relative risk of death within the first 2 weeks after release was 12.7 times that among other state residents (95% CI, 9.2 to 17.4). If the mortality rate among former inmates were the same as that among other state residents of the same age, sex, and race, only 3 of the 38 deaths occurring within the first 2 weeks after release would have been expected. The mortality rate within the first week after release was even higher: 3661 per 100,000 person-years (95% CI, 2511 to 5399).
The adjusted relative risk of death among former inmates, as compared with other state residents, was significantly higher among women than among men (P = 0.002) (). The relative risk of death among released inmates, as compared with other state residents, also varied according to age (P<0.001) and race (P = 0.008).
The leading cause of death among former inmates was drug overdose (103 deaths) (), representing nearly a quarter of all deaths. Of the 38 deaths occurring within 2 weeks after release, 27 were from overdoses. Within the first 2 weeks after release, the rate of death from overdose was 1840 per 100,000 person-years (95% CI, 1213 to 2677). The adjusted relative risk of death from overdose was 129 (95% CI, 89 to 186) among released inmates within 2 weeks after release, as compared with other state residents. Cocaine was involved in the largest number of deaths from overdose (50), followed by deaths involving use of psychostimulants, including methamphetamine (19), heroin (18), and methadone (18). Of deaths from overdose, 27 involved more than one substance (cocaine, psychostimulants, heroin, methadone, benzodiazepines, tricyclic antidepressants, or alcohol). Of 17 deaths from overdose of antidepressants, 13 involved tricyclic antidepressants.
Leading Causes of Death after Release from Prison.
The second leading cause of death was cardiovascular disease (56 deaths); of these deaths, 10 were caused by acute myocardial infarctions and 3 involved cocaine use. Homicide was the cause of the third highest absolute number of deaths (54) and the second highest number of excess deaths. Suicide, cancer, and motor vehicle accidents were also important causes of death. Deaths from cancer of the lung or bronchus represented nearly half of all deaths from cancer. Deaths from overdose, homicide, and suicide were more common among persons younger than 45 years, whereas deaths from cardiovascular disease and cancer were more common among those 45 years of age or older (). Firearms were involved in 54 deaths, including 36 homicides, 10 suicides, 5 legal interventions, and 1 accident.
Deaths among Former Inmates, According to Age Group at the Time of Most Recent Release and Cause of Death.*
One hundred thirty-nine inmates died while in prison during an estimated 69,230 person-years from July 1999 through December 2003. The overall mortality rate during incarceration was 201 deaths per 100,000 person-years (). Among inmates, deaths from drug overdose occurred at a rate of 1.2, homicide at a rate of 5.0, and motor vehicle accidents at a rate of 1.2 deaths per 100,000 person-years, considerably less than the mortality rates for these causes after release. For nearly all causes of death, the rates among former inmates were substantially higher than those among inmates.
Mortality Rates among Former Inmates of Washington State Prisons and Crude Mortality Rates among Current Prison Inmates during the Study Period.