This thesis examines mortality rates among adults who experienced full-time imprisonment in New South Wales between January 1988 and December 2002, by record linkage to the Australian National Death Index. The cohort included 76383 men and 8820 women. Over a mean follow-up of 7.7 years, 5137 deaths (4724 men, 423 women) were identified. Three hundred and three deaths (295 men, eight women) occurred in custody. The median age at death was 36.6 years for men and 32.7 years for women. The prominent causes of death were drug overdose, suicide, accidental and cardiovascular disease. The crude mortality rate was 797 per 100000 person-years for men and 685 per 100000 person-years for women. Risk of mortality was 3.7 times greater in male and 7.8 times greater in female prisoners than the standard population. The excess mortality was substantially raised following release from prison in both men (standardised mortality ratio 4.0 vs 1.7) and women (standardised mortality ratio 8.2 vs 2.1). The period of highest risk of death was the first two weeks after release. Drug overdose was the main cause of death, responsible for 68% of the deaths in the first two weeks for men and for 90% of the deaths in this period for women. In men, there was also a clustering of suicide directly after release. Prisoners admitted to prison psychiatric hospital, repeat offenders and those in the early stage of followup were at increased risk of mortality. Violent offenders were overrepresented in suicide figures and property offenders in death from overdose. Minority groups, in particular men, had a lower risk of death than white people. The above findings reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Prison represents a potential opportunity for treatment and public health intervention to address some of the health problems underlying the high mortality found in this study. The key challenge is, however, to provide a continuum of care between the prison and community.

This thesis examines mortality rates among adults who experienced full-time imprisonment in New South Wales between January 1988 and December 2002, by record linkage to the Australian National Death Index. The cohort included 76383 men and 8820 women. Over a mean follow-up of 7.7 years, 5137 deaths (4724 men, 423 women) were identified. Three hundred and three deaths (295 men, eight women) occurred in custody. The median age at death was 36.6 years for men and 32.7 years for women. The prominent causes of death were drug overdose, suicide, accidental and cardiovascular disease. The crude mortality rate was 797 per 100000 person-years for men and 685 per 100000 person-years for women. Risk of mortality was 3.7 times greater in male and 7.8 times greater in female prisoners than the standard population. The excess mortality was substantially raised following release from prison in both men (standardised mortality ratio 4.0 vs 1.7) and women (standardised mortality ratio 8.2 vs 2.1). The period of highest risk of death was the first two weeks after release. Drug overdose was the main cause of death, responsible for 68% of the deaths in the first two weeks for men and for 90% of the deaths in this period for women. In men, there was also a clustering of suicide directly after release. Prisoners admitted to prison psychiatric hospital, repeat offenders and those in the early stage of followup were at increased risk of mortality. Violent offenders were overrepresented in suicide figures and property offenders in death from overdose. Minority groups, in particular men, had a lower risk of death than white people. The above findings reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Prison represents a potential opportunity for treatment and public health intervention to address some of the health problems underlying the high mortality found in this study. The key challenge is, however, to provide a continuum of care between the prison and community.