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David L. Rosen, PhD, Victor J. Schoenbach, PhD and David A. Wohl, MD

At the time of this study, David L. Rosen was an MD/PhD student at the University of North Carolina Schools of Medicine and Public Health, Chapel Hill. David A. Wohl is with the University of North Carolina Schools of Medicine and Public Health, Chapel Hill. Victor J. Schoenbach is with the University of North Carolina School of Public Health, Chapel Hill.

Correspondence: Requests for reprints should be sent to Victor J. Schoenbach, PhD, Department of Epidemiology, CB#7436, UNC School of Public Health, Chapel Hill, NC 27599-7436 (e-mail: vjs{at}unc.edu).

Objectives. We compared mortality of ex-prisoners and other state residents to identify unmet health care needs among former prisoners.

Methods. We linked North Carolina prison records with state death records for 1980 to 2005 to estimate the number of overall and cause-specific deaths among male ex-prisoners aged 20 to 69 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the number of expected deaths had they experienced the same age-, race-, and cause-specific death rates as other state residents.

Results. All-cause mortality among White (SMR = 2.08; 95% confidence interval [CI] = 2.04, 2.13) and Black (SMR = 1.03; 95% CI = 1.01, 1.05) ex-prisoners was greater than for other male NC residents. Ex-prisoners' deaths from homicide, accidents, substance use, HIV, liver disease, and liver cancer were greater than the expected number of deaths estimated using death rates among other NC residents. Deaths from cardiovascular disease, lung cancer, respiratory diseases, and diabetes were at least 30% greater than expected for White ex-prisoners, but less than expected for Black ex-prisoners.

Conclusions. Ex-prisoners experienced more deaths than would have been expected among other NC residents. Excess deaths from injuries and medical conditions common to prison populations highlight ex-prisoners' medical vulnerability and the need to improve correctional and community preventive health services.