Survival among Georgia Prison Releasees in Rural vs. Urban Residential Locations: A Retrospective, Observational Study Open Access

Lloyd, Shawnta Lynette (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/s1784k92m?locale=en%5D
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Abstract

OBJECTIVES: The residential location to which former prisoners will return may play an important role in the determination of post-release survival. The primary objective of this study was to assess the association of residential location with all-cause mortality, disease-specific natural deaths and cause-specific unnatural deaths among a cohort of prisoners released from Georgia prisons during 1991-2010 and 5 years post-release. The secondary objective was to assess the independent association of residential location with mortality types, adjusting for demographic and incarceration factors.
METHODS: Information obtained from the Georgia Department of Corrections for prisoners who were incarcerated in the state of Georgia on June 30, 1991 was linked to death information from the Georgia Death Registry and National Death Index. Using a retrospective cohort design, the 19.5-year survival and 5-year survival post-release were assessed using Cox proportional hazard models for eligible prisoners after the latest release.
RESULTS: There were 16,407 eligible releasees in this cohort, of whom 3,041 died from 1991-2010 and 1,366 died 5 years post-release. Among releasees from urban, metropolitan areas, there was an increased risk due to natural causes within 5 years after release from prison(adjusted hazard ratio, 1.80; 95% CI 1.04 to 3.12). Releasees from urban, metropolitan areas had an increased risk of mortality due to natural and unnatural causes of death during the 19.5 year study period as well as all-cause and unnatural deaths within 5 years post-release; however, this increased risk was not significant. Likewise, releasees from rural, non-metropolitan areas experienced an increased risk of mortality due to all-cause deaths during the 19.5 year study period, but these results were not significant.
CONCLUSION: Urban residential location was associated with increased mortality due to natural causes, 5 years post-release. There was not a significant difference in mortality based on the type of resident in which the releasees lived due to all causes of death, natural and unnatural deaths from 1991-2010 or all causes of death and unnatural deaths five years after release. Georgia prison releasees with chronic, infectious, and mental illness may need additional resources in urban, metropolitan areas to prevent premature death.

Table of Contents

Table of Contents
Chapter I: Background/Literature Review
Incarceration in the Unites States 2
Who is in Prison? 4
Prisoner Health 5
Substance Abuse 5
Mental Illness 6
Infectious Disease 7
Chronic Disease 7
Post-release Issues 8
Post-Release Mortality 10
Health in Urban and Rural Areas 12
Relevance of Current Study 16
Chapter II: Manuscript
Introduction 21
Methods 23
Results 26
Discussion 29
Tables and Figures 34
Chapter III: Summary, Public Health Implications, and Possible Future Directions
Summary 42
Public Health Implications 42
Possible Future Studies 45
References 48
Appendices
APPENDIX A: IRB Exemption Letter 56 APPENDIX B: Additional Tables 57

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