Long Term Mortality in a Cohort of Persons Imprisoned in Georgia, 1991

Healthcare decision makers can use both short-term and long-term mortality studies to inform the discussion regarding optimal allocation of resources. Prisoners bear a burden of infectious and chronic disease disproportionate to their representation in the general population. What impact does this increased burden have on the timing and causes of mortality? A number of studies of survival after release from incarceration have shown high mortality in the immediate post-discharge period. Instead of concentrating on discharge cohorts, we are examining a cross section of the entire population imprisoned in the state of Georgia fifteen years ago. This study has a substantial amount of person-time follow-up compared to many previous U.S. studies of prisoners. The comprehensive cohort of state prisoners was matched to Georgia's Death Registry and the National Death Index. Preliminary comparisons of mortality in the cohort over subsequent years compared to the state's general population, adjusted for age, gender and race, do not show striking disparities. Individual factors, such as HIV status and type of crime, will be considered when looking at survival time. For example, HIV+ prisoners appear to die much earlier than those with a negative test. The survival of prisoners with a drug crime appears to be negatively affected in later years (age 60+), but there appears to be little difference in the survival time of prisoners based on violent charges. Cause-specific rates and rate ratios, time-specific rates (after release), standardized mortality ratios, and survival analysis after release from prison will be discussed further.