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Study finds high death rate among people who are or have been incarcerated


People recently released from correctional facilities in Ontario had a risk of dying from a drug overdose 56 times greater than the general population, a new study has found.

The life expectancy of people who are or have been incarcerated was also shorter than the general Canadian population, by 10.6 years for women and 4.2 years for men, according to the study published today in CMAJ Open.

“This is the first Canadian study to examine mortality rates in this population both during incarceration and after release,” said Dr. Fiona Kouyoumdjian, a public health physician and post-doctoral fellow with the Centre for Research on Inner City Health of St. Michael’s Hospital. “This study reveals a very high death rate in people who spend any time in provincial custody.”

The study obtained data from the Ontario Ministry of Community Safety and Correctional Services on the nearly 50,000 people admitted to Ontario provincial correctional facilities in 2000, and then looked at death records at the Institute for Clinical Evaluative Sciences to determine how many of these people died between 2000 and 2012 and what they died of.

Dr. Kouyoumdjian said there may be opportunities to intervene during incarceration to prevent people from dying from causes such as overdose. These may include initiatives to divert people from incarceration to treatment programs, better access to drug substitution therapies and treatment programs, overdose prevention training and access to naloxone, which can reverse overdoses when they occur.

Dr. Kouyoumdjian said her study also found that the death rate for this population between 2000 and 2012 was four times as high as the rate for the general population over age 15. Of the 48,166 prisoners studied, 4,126 died, or 8.6 per cent.

While in custody, the death rate was double that of the general population.

Dr. Kouyoumdjian said the consistently high death rate, both in custody and after release to the community, suggests that it is not simply the experience of incarceration that increases the risk of death, but rather that this population is likely at high risk of death due to complex social, medical, and behavioural factors.

The most common cause of death among people who experienced incarceration was injury (which includes overdoses and suicides), diseases of the circulatory system and cancer.

In Canada there are more than 250,000 admissions to correctional facilities each year and about 40,000 people in correctional facilities on any given day – about one in every 250 people.

This study received funding from a 2013 University of Toronto Postgraduate Research Award to Dr. Kouyoumdjian.

"Mortality over 12 years of follow-up in people admitted to provincial custody in Ontario: a retrospective cohort study" was published today in the journal CMAJ Open.

Author block: Kouyoumdjian FG, Kiefer L, Wobeser W, Gonzalez A, Hwang SW.

About St. Michael's Hospital – St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario


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