本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00344-1

摘要内容如下：

背景

以前被监禁的人健康状况特别差，与普通人群相比，他们可预防的死亡风险更高。然而，对这一人群死亡率的流行病学了解不够，特别是特定亚组和地区的死亡率、死亡原因和死亡时间，无法为制定有针对性的循证应对措施提供信息。我们的目的是记录从监禁释放后死亡的发生率、时间、原因和危险因素。

方法

我们分析了多国监禁释放后死亡率联盟（MARIC）研究的相关行政数据。我们调查了1980年至2018年八个国家（澳大利亚、巴西、加拿大、新西兰、挪威、苏格兰、瑞典和美国）释放的1471526名监禁者的死亡率结果，随访时间为10534441人年（每人0-24年）。我们合并了来自18项队列研究的数据，使用两步个体参与者数据荟萃分析来估计特定时间段（第一，从第1天到第14天；第二，每周从第3-12周开始；第三，第13-52周合并；第四，第53周及以上合并；第五，总随访），按年龄、性别和地区进行总体分层。

调查结果

有75427人死亡。释放后第一周的全因CMR（1612[95%CI 1048-2287]）高于所有其他时间段（与第2周相比的发生率比[IRR]:1.5[95%CI 1.2-1.8]，I2=26.0%，第3-4周:2.0[1.5-2.6]，I2=53.0%，第9-12周:2.2[1.6-3.0]，I2=70.5%）。第一周最高的原因特异性死亡率是由于酒精和其他药物中毒（CMR 657[95%CI 332-1076]）、自杀（135[36-277]）和心血管疾病（71[16-153]）。我们观察到，随着释放时间的推移，不同地区的病因特异性CMR有相当大的变化。合并的全因CMR在男性（731[95%CI 630-839]）和女性（660[560-767]）之间相似，并且在老年组中更高。

解释

释放后第一周的死亡率显著上升，突出表明迫切需要对循证、协调的过渡性医疗保健进行投资，包括治疗精神疾病和物质使用障碍，以防止释放后因自杀和用药过量而死亡。死亡率和死亡原因的时间变化突出了对释放后死亡率进行常规监测的必要性。

英文原文如下：

Abstracts

BACKGROUND  Formerly incarcerated people have exceptionally poor health profiles and are at increased risk of preventable mortality when compared with their general population peers. However, not enough is known about the epidemiology of mortality in this population-specifically the rates, causes, and timing of death in specific subgroups and regions-to inform the development of targeted, evidence-based responses. We aimed to document the incidence, timing, causes, and risk factors for mortality after release from incarceration.

METHODS  We analysed linked administrative data from the multi-national Mortality After Release from Incarceration Consortium (MARIC) study. We examined mortality outcomes for 1 471 526 people released from incarceration in eight countries (Australia, Brazil, Canada, New Zealand, Norway, Scotland, Sweden, and the USA) from 1980 to 2018, across 10 534 441 person-years of follow-up (range 0-24 years per person). We combined data from 18 cohort studies using two-step individual participant data meta-analyses to estimate pooled all-cause and cause-specific crude mortality rates (CMRs) per 100 000 person-years, for specific time periods (first, daily from days 1-14; second, weekly from weeks 3-12; third, weeks 13-52 combined; fourth, weeks 53 and over combined; and fifth, total follow-up) after release, overall and stratified by age, sex, and region.

FINDINGS  75 427 deaths were recorded. The all-cause CMR during the first week following release (1612 [95% CI 1048-2287]) was higher than during all other time periods (incidence rate ratio [IRR] compared with week 2: 1·5 [95% CI 1·2-1·8], I2=26·0%, weeks 3-4: 2·0 [1·5-2·6], I2=53·0%, and weeks 9-12: 2·2 [1·6-3·0], I2=70·5%). The highest cause-specific mortality rates during the first week were due to alcohol and other drug poisoning (CMR 657 [95% CI 332-1076]), suicide (135 [36-277]), and cardiovascular disease (71 [16-153]). We observed considerable variation in cause-specific CMRs over time since release and across regions. Pooled all-cause CMRs were similar between males (731 [95% CI 630-839]) and females (660 [560-767]) and were higher in older age groups.

INTERPRETATION  The markedly elevated rate of death in the first week post-release underscores an urgent need for investment in evidence-based, coordinated transitional healthcare, including treatment for mental illness and substance use disorders to prevent post-release deaths due to suicide and overdose. Temporal variations in rates and causes of death highlight the need for routine monitoring of post-release mortality.

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