All-cause and external mortality in released prisoners: systematic review and meta-analysis

Am J Public Health. 2012 Dec;102(12):e67-75. doi: 10.2105/AJPH.2012.300764. Epub 2012 Oct 18.


Objectives: We systematically reviewed studies of mortality following release from prison and examined possible demographic and methodological factors associated with variation in mortality rates.

Methods: We searched 5 computer-based literature indexes to conduct a systematic review of studies that reported all-cause, drug-related, suicide, and homicide deaths of released prisoners. We extracted and meta-analyzed crude death rates and standardized mortality ratios by age, gender, and race/ethnicity, where reported.

Results: Eighteen cohorts met review criteria reporting 26,163 deaths with substantial heterogeneity in rates. The all-cause crude death rates ranged from 720 to 2054 per 100,000 person-years. Male all-cause standardized mortality ratios ranged from 1.0 to 9.4 and female standardized mortality ratios from 2.6 to 41.3. There were higher standardized mortality ratios in White, female, and younger prisoners.

Conclusions: Released prisoners are at increased risk for death following release from prison, particularly in the early period. Aftercare planning for released prisoners could potentially have a large public health impact, and further work is needed to determine whether certain groups should be targeted as part of strategies to reduce mortality.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Female
  • Homicide / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Prisoners / statistics & numerical data*
  • Risk Factors
  • Sex Factors
  • Substance-Related Disorders / mortality
  • Suicide / statistics & numerical data
  • Young Adult