Systematic review of record linkage studies of mortality in ex‐prisoners: why (good) methods matter

Stuart Alistair Kinner · Simon J. Forsyth · Gail M. Williams

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Criminal Justice and Corrections Analysis Substance Abuse Treatment and Outcomes Census and Population Estimation

Abstract

AIMS: World-wide, more than 30 million people move through prisons annually. Record linkage studies have identified an increased risk of death in ex-prisoners. In order to inform preventive interventions it is necessary to understand who is most at risk, when and why. Limitations of existing studies have rendered synthesis and interpretation of this literature difficult. The aim of this study was to describe methodological characteristics of existing studies and make recommendations for the design, analysis and reporting of future studies. METHODS: Systematic review of studies using record linkage to explore mortality in ex-prisoners. Based on analysis of these studies we illustrate how methodological limitations and heterogeneity of design, analysis and reporting both hamper data synthesis and create potential for misinterpretation of findings. Using data from a recent Australian study involving 42,015 ex-prisoners and 2329 observed deaths, we quantify the variation in findings associated with various approaches. RESULTS: We identified 29 publications based on 25 separate studies published 1998-2011, mainly from the United Kingdom, United States and Australia. Mortality estimates varied systematically according to features of study design and data analysis. A number of common, avoidable and significant methodological limitations were identified. Substantial heterogeneity in study design, methods of data analysis and reporting of findings was observed. CONCLUSIONS: Record linkage studies examining mortality in ex-prisoners show widely varying estimates that are influenced substantially by avoidable methodological limitations and reducible heterogeneity. Future studies should adopt best practice methods and more consistent methods of analysis and reporting, to maximize policy relevance and impact.

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References

2005Counting the dead and what they died from: an assessment of the global status of cause of death data.2007Release from Prison — A High Risk of Death for Former Inmates 2010Meta‐analysis of drug‐related deaths soon after release from prison 2006Suicide in recently released prisoners: a population-based cohort study 2008A Quality-Effects Model for Meta-Analysis 2011Prisoner Survival Inside and Outside of the Institution: Implications for Health-Care Planning 2003Male drugs‐related deaths in the fortnight after release from prison: Scotland, 1996–99 2008All-Cause and Cause-Specific Mortality Among Men Released From State Prison, 1980–2005

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2014The Case for Improving the Health of Ex-Prisoners 2014The relationship between incarceration and premature adult mortality: Gender specific evidence 2014Suicide in adults released from prison in Queensland, Australia: a cohort study

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