![]() Given the sensitive nature of the study, we did not contact family members or friends to confirm death. 15 If an alias was classified as a true match, the person was considered to have died. 14 The NDI database provided potential matches of deaths for each record we submitted and a probabilistic score to determine which deaths were true matches to former inmates. A second source was the NDI, a computerized database of information abstracted by states from death certificates that indexes deaths in the 50 states, the District of Columbia, the Virgin Islands, and Puerto Rico. ![]() Race or ethnic group is self-reported on entry into the Washington State Department of Corrections. The Department of Corrections provided personal identifiers for all persons released from prison during the study period, including name, known aliases and nicknames, Social Security number, date and state of birth, sex, race, marital status, and dates of incarceration. The study was approved by the Veterans Affairs committee of the institutional review board of the University of Washington and the research review committee of the Washington State Department of Corrections, with a waiver of consent by the University of Washington Human Subjects Division. The final sample consisted of 30,237 former inmates. The 143 inmates reported by the Department of Corrections to have died or to have been executed while incarcerated were excluded if the death occurred during the first or only admission to prison during the study period otherwise, data on former inmates were censored as of the date of readmission to prison before death. Six inmates who were granted extraordinary medical placement and survived until the end of their prison sentences were included in the analysis. Of the 30,636 former inmates, 399 (1%) were excluded from the analysis for the following reasons: age was less 18 years at the time of release (45 persons), data on race were missing (20 persons), date of death reported by the National Death Index (NDI) for a match to a former inmate occurred before the person’s release date but the person was not known to have died in prison (31 persons), the recorded date of release occurred before the date of admission to prison and two attempts to correct the inconsistency by contacting the Department of Corrections did not resolve it (155 persons), or death occurred while the inmate was on “extraordinary medical placement” (compassionate release) for grave illness before the official release date (5 persons). The Washington State prison system does not include jails, and it houses approximately 15,000 felony offenders sentenced to imprisonment for more than 1 year. In this retrospective cohort study, we identified 30,636 persons who were released from the Washington State Department of Corrections between July 1, 1999, and December 31, 2003, from electronic records of the Department of Corrections. Therefore, the objectives of this study were to determine the risk of death among persons released from Washington State prisons, compare the mortality rates among former inmates with those among other state residents, investigate whether the first 2 weeks after release were associated with an elevated risk of death, and describe the major causes of death. Information about the risk and causes of death after release from prison could focus preventive efforts, improve transitional care, and guide policies to improve outcomes. Former inmates may also be at risk for death from violence, unintentional injury, and a lapse in treatment of chronic health conditions. The first few weeks after release might be a time of high vulnerability to drug overdose. 9, 11 A history of prison release 12 and prior arrests 13 has been associated with fatal drug overdoses in Australia and with nonfatal drug overdoses in San Francisco. European studies have suggested that mortality rates after release from prison were high among persons with a history of injection drug use. Studies outside the United States have suggested a high mortality rate after the release from prison, 5 – 11 but these findings have not been confirmed in the United States, and data on the causes of death are limited. Prisoners’ reentry - their return to the community from prison - can be stressful as former inmates try to obtain housing, reintegrate into their families and communities, find employment, 3, 4 and gain access to health care. ![]() 1 At the end of 2001, there were approximately 5.6 million adults who had ever been incarcerated in a state or federal prison, 2 not including stays in local jails. ![]() At the end of 2004, more than 3% of adults in the United States were in jail, in prison, or on probation or parole.
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