204444 Long Term Mortality in a Cohort of Persons Imprisoned in Georgia, 1991

Wednesday, November 11, 2009: 11:35 AM

Ryan Seals , Rollins School of Public Health, Emory University, Atlanta, GA
Victoria Anne McCallum , Rollins School of Public Health, Emory University, Atlanta, GA
Anne C. Spaulding, MD, MPH , Rollins School of Public Health, Emory University, Atlanta, GA
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.

Learning Objectives:
After attending this session, participants will be able to: 1. Explain how mortality information can be obtained from cross-sectional prison cohorts and analyzed. 2. Describe the major causes of death among prisoners and former prisoners and how leading causes of mortality change over time. 3. Relate prisoner mortality to mortality in the general community and describe how differences, if any, change priorities in the allocation of resources inside correctional facilities.

Keywords: Correctional Health Care, Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Anne Spaulding MD MPH has worked in the field of correctional health care for the past 12 years. She served as medical director for the Rhode Island Department of Corrections, a combined jail/prison system, for the first 5 ½ years after her fellowship training in infectious disease. After spending two years at the Center for Disease Control, where she focused on correctional public health, she assumed the position of Associate Medical Director in the Georgia Prison System. She joined the Department of Epidemiology at Rollins School of Public Health in October 2005 as a Research Assistant Professor. Projects include serving as Principal Investigator for the Evaluation and Support Center of an $18M, five year initiative funded by HRSA on linkage of jail inmates to HIV primary care. She is investigating mortality in former and current prison inmates. under a Pfizer Scholars’ Grant in Public Health. She has authored 30 publications on the epidemiology of infectious diseases and other health issues specific to correctional settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.