Risk of Overdose-Related Death for People with a History of Incarceration

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Gan, Wen Qi
Kinner, Stuart A
Nicholls, Tonia L
Xavier, ChloƩ
Urbanoski, Karen
Greiner, Leigh
Buxton, Jane A
Martin, Ruth E
McLeod, Katherine E
Samji, Hasina
Nolan, Seonaid
Meilleur, Louise
Desai, Roshni
Sabeti, Soha
Slaunwhite, Amanda K
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2020
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Abstract

BACKGROUND AND AIMS: Reported associations between previous incarceration and the risk of overdose-related death are substantially heterogeneous and previous studies are limited by an inability to control for confounding factors in risk assessment. This study investigated the associations of overdose-related death with previous incarceration and the number or cumulative duration of previous incarcerations, and individual or neighbourhood characteristics that may potentially modify the associations. Design and setting A cohort study using a 20% random sample of residents in British Columbia, Canada. PARTICIPANTS: 765,690 persons aged 23 years or older at baseline of January 1, 2015. Mean age was 50 years; 49% were males. MEASUREMENTS: Previous incarcerations that occurred during the 5-year exposure period (January 2010 to December 2014) were identified using provincial incarceration records. Overdose-related deaths that occurred during the 3-year follow-up period (January 2015 to December 2017) were identified using linked administrative health data. Baseline individual and neighbourhood characteristics were assessed using the provincial health insurance data. FINDINGS: In the cohort, 5,743 persons had an incarceration history during the exposure period, and 634 persons died from drug overdose during the follow-up period. The mortality rate was 897 and 22 per 100,000 person-years for persons who did and did not have an incarceration history, respectively. After adjusting for baseline individual and neighbourhood characteristics (without any interaction term), persons who had an incarceration history were 4.04 times (95% confidence interval 3.23-5.06) more likely to die from drug overdose compared with persons without an incarceration history. The association was stronger for females, persons without diagnoses of substance use disorder, and persons without dispensation of opioids for pain or benzodiazepines (P < 0.001 for each interaction term). There was no discernible linear trend between the number or cumulative duration of previous incarcerations and the risk of overdose-related death. CONCLUSIONS: Previous incarceration appears to be a major risk factor for overdose-related death.

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Addiction

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Ā© 2020 Society for the Study of Addiction. This is the peer reviewed version of the following article: Risk of Overdoseā€Related Death for People with a History of Incarceration, Addiction, 2020, which has been published in final form at https://doi.org/10.1111/add.15293. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)

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Biomedical and clinical sciences

Criminology

Psychology

cohort studies

confounding factors

drug overdose

incarceration

mortality

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Gan, WQ; Kinner, SA; Nicholls, TL; Xavier, C; Urbanoski, K; Greiner, L; Buxton, JA; Martin, RE; McLeod, KE; Samji, H; Nolan, S; Meilleur, L; Desai, R; Sabeti, S; Slaunwhite, AK, Risk of Overdose-Related Death for People with a History of Incarceration., Addiction, 2020

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