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
About this Master's Thesis
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