Abstract
Background:
Incarceration has been linked to poor mental and physical health outcomes, affecting not only the individuals who experience incarceration, but also their families and wider communities. The time period after release has been identified as a period of key challenges including finding employment, social integration, finding suitable housing and accessing healthcare. International research has found that those released from incarceration present to the ED at higher rates than the non-incarcerated population. Health service use, including emergency department (ED) use, provides informative data on patterns of injury or disease, as well as health risk factors. In NZ, there exist inequities between the rates of Māori and non-Māori incarceration. This overrepresentation of Māori in the criminal justice system results in Māori individuals and their whānau experiencing an increase in the negative health outcomes associated with incarceration. This contributes to the overall health inequities experienced by Māori in NZ.
Aims:
This thesis aims to answer the following questions:
1. What is the prevalence and incidence rate (IR) of ED presentations for those released from incarceration, in the 12 months following their release?
2. What is the prevalence and IR of longer-treatment ED (LT-ED) events for those released from incarceration in the 12 months follow their release?
3. What are the demographic (age, sex) and incarceration (type of incarceration) factors associated with increased rate of ED and LT-ED events in those released from incarceration?
4. What patterns exist among the principal diagnoses of the LT-ED events?
5. What can be understood about the differences between Māori and non-Māori when completing a Te Tiriti-based analysis of these four questions?
Methods:
This thesis examined ED use of those released from incarceration between 1 January 2018 and 31 December 2018, in the 12 months following their release. It used national routine administrative data from the Stats NZ Integrated Data Infrastructure (IDI). The data was analysed and the prevalence and IRs for those who presented to ED, by frequency of ED presentations and ethnicity. The study cohort was also analysed for those who had an LT-ED event in the 12 months after their release, by frequency of presentations and ethnicity. This thesis also detailed information on the ED presentations and LT-ED events by demographic (age, sex) and incarceration characteristics (type of incarceration). Diagnosis information for the LT-ED events was analysed. Age and sex standardised rates of ED use and LT-ED events were compared for Māori and non-Māori, and for those released from remand and prison.
Results:
This thesis emphasised the prevalence of ED utilisation among individuals released from incarceration in NZ. Of the study cohort, 4,815 individuals (35.2%) sought ED care at least once within the first 12 months after release from incarceration. Of the study cohort, 4.9% were identified as frequent ED attenders (4+ ED events over the 12 month follow-up period), while 30.3% were categorised as irregular ED attenders (1-3 ED events over the 12 month follow-up period). Furthermore, 17.3% of the study cohort (2,373 individuals) had at least one LT-ED event (treatment of 3 hours or more) during the 12 month post-release period. Frequent LT-ED attendance was most common amongst Māori aged 55+. Females showed notably higher rates of ED presentations and LT-ED events compared to males. Individuals released from remand had higher rates of both ED presentations and LT-ED events compared to individuals released from prison. There was a larger proportion of ED presentations and LT-ED events that occurred within the first week of release from incarceration, compared to the remaining 51 weeks of follow-up time. Of the 3,687 LT-ED events experienced by the study cohort during the follow-up period, 38.2% had an injury-related principal diagnosis. Head injuries emerged as the predominant diagnostic subcategory, and assault was identified as the most common external cause behind the injury-related LT-ED events.
Conclusion:
Those released from incarceration have high rates of both ED presentations and longer-treatment ED events, particularly in the first week after their release. Females had significantly higher rates of ED and LT-ED events, compared to males. Those released on remand were identified as a group with high ED use, compared to those released from prison. Assault was the most common external cause behind the LT-ED events resulting from injury, and head injuries were the most common diagnosis subcategory. These findings underscore significant health needs of individuals post-incarceration, emphasizing the need to focus on this population within public health policy, research and practice.