Papers - Abstracts

Mortality from overdose among injecting drug users recently released from
prison: database linkage study

S R Seaman, R P Brettle, S M Gore

Abstract

Objective:

To assess whether injecting drug users have a higher than usual risk of
death from overdose in the 2 weeks after release from prison.

Design:

Soundex coding of surnames and information on date of birth were used to
link entry and release dates from the local prison between 1983 and 1994
with clinical data from Edinburgh City Hospital's cohort of male injecting
drug users who are infected with HIV.

Setting:

Edinburgh City Hospital and Edinburgh Prison.

Subjects:

316/332 male injecting drug users infected with HIV in the City Hospital HIV
cohort; 16 were excluded because they were enrolled after developing AIDS or
because their precise date of death was not available.

Main outcome measure:

Relative risk of dying from overdose before developing AIDS and relative
risk of dying of all causes before developing AIDS during the 2 weeks after
release from prison; this was compared with relative risks of death during
other time at liberty.

Results:

238/316 (75%) injecting drug users served time in the prison between 1983
and 1994. 33 out of 316 injecting drug users who were infected with HIV died
before developing AIDS during 517 177 days at risk.

20 of these men died of an overdose; 6 of these deaths occurred within 2
weeks of release during 5903 days at risk. Death rates from overdose before
the development of AIDS were 1.02/1000 days during the 2 weeks after release
(recently released) and 0.029/1000 days during other times of liberty.

The relative risk of death from overdose became 7.7 (1.5 to 39.1) after
temporal matching (when the comparison was limited to the first 2 weeks
after release versus the next 10 weeks). The crude relative risk in an
analysis combining stratified prison term and the 2 weeks after release was
4.5 (1.7 to 11.7) for death from overdose. After temporal matching these
risks became 1.8 (0.4 to 9.2).

Conclusion:

Prisons should evaluate interventions to reduce the risk of death from
overdose after release.

Medical Research Council Biostatistics Unit, Institute of Public Health,
Cambridge CB2 2SR S R Seaman, PhD student S M Gore, senior statistician

Regional Infectious Diseases Unit, City Hospital, Edinburgh EH11 3XA
R P Brettle, consultant

Correspondence to: Dr Gore: email: sheila.gore@mrc-bsu.cam.ac.uk