BACKGROUND: High mortality rates, particularly from overdose, after release from state prison systems are well documented. However, little is known about mortality rates after release from holding facilities where individuals await sentencing. The purpose of this study was to assess the risk of death and determine the demographic and incarceration related risk factors for all-cause and overdose-specific mortality following release from the Philadelphia Prison System (PPS), a detention facility for individuals awaiting sentencing.
METHODS: We conducted a retrospective cohort study of inmates released from PPS between 2010 and 2015. Prison records were linked to drug intoxication fatality data from the Philadelphia Medical Examiner’s Office (MEO) and death certificate records from the Pennsylvania Department of Health (PDoH) Vital Statistics Program. All-cause and overdose-specific mortality rates among previously incarcerated individuals in Philadelphia were compared to other Philadelphia residents by using indirect standardization adjusting for age, sex, and race/ethnicity. Cox proportional hazards regression was used to determine risk factors for all-cause and overdose-specific death among individuals released from PPS.
RESULTS: Of the 75,819 individuals released from PPS between 2010 and 2015, 1,920 (2.5%) individuals died from any cause, of whom 657 (34%) succumbed to unintentional drug overdose. Previously incarcerated individuals had an elevated risk of all-cause mortality and a dramatically higher risk of overdose death than the non-incarcerated population in Philadelphia (Standardized Mortality Ratio [SMR] 1.70, 95% CI 1.63-1.78 and SMR 6.94, 95% CI 6.41-7.48, respectively) after adjusting for age, race/ethnicity, and sex. Among individuals recently released from PPS, black, non-Hispanic individuals (Hazard Rate [HR] 0.16, 95% CI 0.14-0.19) and Hispanic individuals (HR 0.49, 95% CI 0.41-0.57) were at lower risk for overdose following prison release than white, non-Hispanic individuals. Recently released individuals with a documented serious mental illness (SMI) were at higher risk of post-release overdose (HR 1.78, 95% CI 1.43-2.21) than those released without a documented SMI, as were individuals with two or more incarcerations during the study period (HR 2.35, 95% CI 1.11-2.37).
CONCLUSIONS: Previously incarcerated, but non-adjudicated, individuals are at high risk of mortality, particularly from drug overdose, upon discharge. Appropriate prevention measures including behavioral health treatment referral, overdose awareness education, and take-home naloxone may help to reduce the risk of death after release.