狱中阿片类受体激动剂治疗对挪威刑满释放人员全因死亡率和用药过量死亡率的估计影响:对挪威监狱释放研究(nPRIS)数据的前瞻性分析。

IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2024-07-01 DOI:10.1016/S2468-2667(24)00098-7
Anne Bukten, Marianne Riksheim Stavseth
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引用次数: 0

摘要

背景:用药过量是导致刑满释放人员死亡的主要原因,而阿片类激动剂治疗与降低入狱后的死亡率有关。然而,很少有研究探讨了可改变的潜在风险因素和保护因素对出狱后死亡率的相互影响。我们旨在描述 2000-22 年间挪威监狱释放人员的全因死亡率和用药过量死亡率,并确定与这些人员 6 个月内两种死亡率相关的原有风险因素:在这项前瞻性分析中,我们使用了挪威监狱释放研究(nPRIS)、挪威死因登记处、挪威监狱登记处、挪威病人登记处和挪威统计局提供的数据,其中包括2000年1月1日至2022年12月31日期间挪威监狱中的所有人员。在此期间开放的所有挪威监狱均被纳入研究范围。没有挪威个人身份号码或在监狱外服刑的人员不在分析之列。为了确定与刑满释放人员的全因死亡率和用药过量死亡率相关的原有风险因素,我们在 2010 年 1 月 1 日对观察期进行了左截断,从而创建了一个个人子样本。我们计算了粗死亡率 (CMR) 和相应的 95% CI,即释放后几个时间段内每 10 万人年的死亡人数。主要结果是根据 ICD-10 评估的所有参与者的全因死亡率和用药过量死亡率,并通过两个独立的 Cox 比例危险模型进行分析:nPRIS队列共包括112 877名2000年至2022年间从挪威监狱释放的人员,其中11 995人(10-6%)为女性,100 865人(89-4%)为男性。在这 1 463 035 人年中,我们发现了 13 004 例全因死亡和 3085 例药物过量死亡。全因死亡率的估计CMR为每10万人年889例(95% CI为874-904例),过量死亡率为每10万人年211例(203-218例)。在2010-22年期间入狱前被诊断患有阿片类药物使用障碍的人员中(n=6830),在对社会人口学、监狱相关和临床特征进行调整后,估计提供阿片类药物激动剂治疗与出狱后6个月内全因死亡率(危险比0-58,95% CI 0-39-0-85)和过量死亡率(0-51,0-31-0-82)的降低有关:挪威监狱释放的被诊断患有阿片类药物使用障碍的人员中,在狱中接受阿片类药物激动剂治疗是6个月内全因死亡率和用药过量死亡率的保护因素。在狱中提供阿片类激动剂治疗对降低出狱后6个月的死亡率至关重要,所有有治疗需求的狱中人员都应接受治疗:挪威东南部地区卫生局和挪威研究理事会。
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Estimated effects of opioid agonist treatment in prison on all-cause mortality and overdose mortality in people released from prison in Norway: a prospective analysis of data from the Norwegian Prison Release Study (nPRIS).

Background: Overdose is the leading cause of death for people released from prison, and opioid agonist treatment is associated with reductions in mortality after imprisonment. However, few studies have explored the interplay of the potential modifiable risk factors and protective factors for mortality after release from prison. We aimed to describe all-cause mortality and overdose mortality among individuals released from Norwegian prisons during 2000-22 and to identify pre-existing risk factors associated with both types of mortality among these individuals for 6 months.

Methods: For this prospective analysis, we used data from the Norwegian Prison Release Study (nPRIS), which includes all people in prison in Norway between Jan 1, 2000, and Dec 31, 2022; the Norwegian Cause of Death Registry; the Norwegian Prison Registry; the Norwegian Patient Registry; and Statistics Norway. All prisons in Norway that were open during this period were included. People who did not have a Norwegian personal identification number or were serving their sentence outside of prison units were excluded from this analysis. To identify pre-existing risk factors associated with all-cause and overdose mortality among people released from prison, we left-censored the observation period on Jan 1, 2010, creating a subsample of individuals. We calculated crude mortality rates (CMRs) and corresponding 95% CIs as the number of deaths per 100 000 person-years for several time periods after release. The primary outcomes were all-cause mortality and overdose mortality according to the ICD-10, assessed in all participants and analysed via two separate Cox proportional-hazards models.

Findings: The total nPRIS cohort included 112 877 individuals released from prison in Norway between 2000 and 2022, 11 995 (10·6%) of whom were female and 100 865 (89·4%) of whom were male. We identified 13 004 instances of all-cause mortality and 3085 instances of overdose mortality during the 1 463 035 person-years. The estimated CMR for all-cause mortality was 889 (95% CI 874-904) per 100 000 person-years and for overdose mortality was 211 (203-218) per 100 000 person-years. Among people diagnosed with opioid use disorder before entering prison during 2010-22 (n=6830), provision of opioid agonist treatment was estimated to be associated with reductions in both all-cause mortality (hazard ratio 0·58, 95% CI 0·39-0·85) and overdose mortality (0·51, 0·31-0·82) in the 6 months after leaving prison after adjustment for sociodemographic, prison-related, and clinical characteristics.

Interpretation: In people diagnosed with opioid use disorder released from Norwegian prisons, opioid agonist treatment provided while in prison was a protective factor for both all-cause and overdose mortality at 6 months. Provision of opioid agonist treatment while in prison is crucial in reducing mortality for 6 months after release and should be available to all people in prison who have treatment needs.

Funding: South-Eastern Norway Regional Health Authority and the Research Council of Norway.

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来源期刊
Lancet Public Health
Lancet Public Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
55.60
自引率
0.80%
发文量
305
审稿时长
8 weeks
期刊介绍: The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.
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