Table 3. Findings From Observational Studies on the Pooled Cause-Specific Rates Among People Receiving OAT, by Time During Incarceration and After Release From Incarceration.
| Settinga | No. of cohorts | No. of people | With OAT | Without OAT | Rate ratio (with OAT/without OAT) | I2, % | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Deaths | PY | Pooled CMR (95% CI) | I2, % | Deaths | PY | Pooled CMR (95% CI) | I2, % | |||||
| Mortality during incarceration 18 , b | ||||||||||||
| First 4 wk in prison | ||||||||||||
| All-cause | 1 | 16 715 | 1 | 1308 | 0.77 (0.11-5.43) | NA | 16 | 1263 | 12.67 (7.76-20.68) | NA | 0.06 (0.01-0.46) | NA |
| Drug-related | 1 | 16 715 | 0 | 1308 | NA | NA | 1 | 1263 | 0.79 (0.11-5.62) | NA | NAc | NA |
| Suicide | 1 | 16 715 | 1 | 1308 | 0.77 (0.11-5.43) | NA | 9 | 1263 | 7.13 (3.71-13.70) | NA | 0.11 (0.01-0.85) | NA |
| Remainder in prison | ||||||||||||
| All-cause | 1 | 16 715 | 10 | 15 132 | 0.66 (0.36-1.23) | NA | 24 | 13 285 | 1.81 (1.21-2.70) | NA | 0.37 (0.17-0.76) | NA |
| Drug-related | 1 | 16 715 | 0 | 15 132 | NA | NA | 5 | 13 285 | 0.38 (0.16-0.90) | NA | NAc | NA |
| Suicide | 1 | 16 715 | 2 | 15 132 | 0.13 (0.03-0.53) | NA | 7 | 13 285 | 0.53 (0.25-1.11) | NA | 0.25 (0.05-1.21) | NA |
| Total time in prison | ||||||||||||
| All-cause | 1 | 16 715 | 11 | 16 440 | 0.67 (0.37-1.21) | NA | 40 | 14 548 | 2.75 (2.02-3.75) | NA | 0.24 (0.12-0.47) | NA |
| Drug-related | 1 | 16 715 | 0 | 16 440 | NA | NA | 6 | 14 548 | 0.41 (0.19-0.92) | NA | NAc | NA |
| Suicide | 1 | 16 715 | 3 | 16 440 | 0.18 (0.06-0.57) | NA | 16 | 14 548 | 1.10 (0.67-1.80) | NA | 0.17 (0.05-0.57) | NA |
| Mortality after release from incarceration d | ||||||||||||
| First 4 wk after release47,71 | ||||||||||||
| All-cause | 2 | 28 713 | 25 | 2856 | 8.76 (5.92-12.96) | 0 | 95 | 2578 | 36.85 (30.14-45.06) | 0 | 0.24 (0.15-0.37) | 0 |
| Drug-related | 2 | 28 713 | 10 | 2856 | 3.55 (1.91-6.61) | 0 | 47 | 2578 | 21.11 (10.74-41.52) | 79.5 | 0.19 (0.10-0.37) | 0 |
| Suicide | 2 | 28 713 | 0 | 2856 | NA | NA | 3 | 2578 | 1.23 (0.40-3.82) | 0 | NAc | 0 |
| Remainder after release47,71 | ||||||||||||
| All-cause | 2 | 28 713 | 212 | 21 812 | 9.98 (7.99-12.46) | 60.4 | 245 | 19 828 | 12.42 (10.96-14.07) | 0 | 0.82 (0.58-1.15) | 65.3 |
| Drug-related | 2 | 28 713 | 66 | 21 812 | 3.13 (0.70-13.91) | 97.1 | 95 | 19 828 | 5.29 (2.75-10.20) | 90.4 | 0.59 (0.25-1.36) | 84.7 |
| Suicide | 2 | 28 713 | 18 | 21 812 | 0.87 (0.20-3.87) | 89.2 | 13 | 19 828 | 0.73 (0.32-1.64) | 55.5 | 1.19 (0.58-2.47) | 0 |
| Total time after release | ||||||||||||
| All-cause47,60,71 | 3 | 29 004 | 279 | 25 275 | 18.92 (6.57-54.46) | 98.6 | 360 | 22 666 | 23.83 (12.66-44.87) | 95.6 | 0.72 (0.52-1.00) | 67.1 |
| Drug-related47,71 | 2 | 28 713 | 76 | 24 669 | 3.30 (0.87-12.47) | 97.0 | 142 | 22 407 | 6.98 (3.97-12.29) | 91.1 | 0.47 (0.22-1.01) | 85.9 |
| Suicide47,71 | 2 | 28 713 | 18 | 24 669 | 0.78 (0.17-3.60) | 89.8 | 16 | 22 407 | 0.79 (0.37-1.70) | 58.7 | 0.97 (0.45-2.08) | 17.7 |
| Mortality after release from incarceration e | ||||||||||||
| First 4 wk after release71 | ||||||||||||
| All-cause | 1 | 16 453 | 17 | 2129 | 7.98 (4.96-12.84) | NA | 79 | 2172 | 36.37 (29.17-45.35) | NA | 0.22 (0.13-0.37) | NA |
| Drug-related | 1 | 16 453 | 6 | 2129 | 2.82 (1.27-6.27) | NA | 33 | 2172 | 15.19 (10.80-21.37) | NA | 0.19 (0.08-0.44) | NA |
| Suicide | 1 | 16 453 | 0 | 2129 | NA | NA | 2 | 2172 | 0.92 (0.23-3.68) | NA | NAc | NA |
| Remainder after release71 | ||||||||||||
| All-cause | 1 | 16 453 | 46 | 13 309 | 3.46 (2.59-4.61) | NA | 276 | 16 333 | 16.90 (15.02-19.02) | NA | 0.20 (0.15-0.28) | NA |
| Drug-related | 1 | 16 453 | 9 | 13 309 | 0.68 (0.35-1.30) | NA | 68 | 16 333 | 4.16 (3.28-5.28) | NA | 0.16 (0.08-0.33) | NA |
| Suicide | 1 | 16 453 | 4 | 13 309 | 0.30 (0.11-0.80) | NA | 9 | 16 333 | 0.55 (0.29-1.06) | NA | 0.55 (0.17-1.77) | NA |
| Total time after release | ||||||||||||
| All-cause62,71 | 2 | 18 435 | 66 | 16 684 | 3.98 (3.13-5.07) | 0 | 382 | 18 890 | 36.21 (10.16-129.00) | 97.6 | 0.09 (0.02-0.56) | 88.0 |
| Drug-related71 | 1 | 16 453 | 15 | 16 453 | 0.97 (0.59-1.61) | NA | 101 | 18 505 | 5.46 (4.49-6.63) | NA | 0.18 (0.10-0.31) | NA |
| Suicide71 | 1 | 16 453 | 4 | 16 453 | 0.30 (0.10-0.69) | NA | 11 | 18 505 | 0.59 (0.33-1.07) | NA | 0.44 (0.14-1.37) | NA |
Abbreviations: CMR, crude mortality rates; NA, not available; OAT, opioid agonist treatment; PY, person-years of follow-up.
“First 4 wk” refers to the first 4 weeks in or out of incarceration; “remainder” refers to remainder of time in incarceration or after release; “total time” refers to total time spent in incarceration, or total time after release up to 12 months after release from incarceration. Additional causes of mortality and for all forest plots pertaining to this table are displayed in eAppendix 8 in the Supplement.
“With OAT” data represent time spent with OAT during incarceration; “Without OAT” data represent time spent without OAT during incarceration.
Rate ratios are suppressed where at least half of the studies reported 0 deaths for 1 of the time periods involved.
“With OAT” data represent individuals who left incarceration on OAT; “Without OAT” data represent individuals who left incarceration not on OAT.
“With OAT” data represent time spent with OAT after release from incarceration: “Without OAT” data represent time spent without OAT after release from incarceration.