The impact of incarceration on injecting-related injuries and diseases: A longitudinal cohort study.

Author: Samantha Colledge-Frisby, Mark Stoove, Rebecca Winter, Ashleigh Stewart, Michael Curtis, Michael Livingston, Tony Butler, Campbell Aitken, Stuart Kinner, Paul Dietze

Theme: Epidemiology & Public Health Research Year: 2023

Background: In Australia, people who inject drugs in prison have no access to sterile injecting equipment. While incarcerated, people are more likely to share and re-use needles, clean their needle/injecting site with saliva, and rush injections. The assumption, therefore, is that risk of injecting-related injuries and diseases (IRID) increase for people who inject drugs in prison. However, IRID risk during and following incarceration, disaggregated by reporting in-prison injecting, has not been investigated empirically.

Methods: Data were drawn from 400 men participating in the Prison and Transition Health (PATH) study who injected drugs at least monthly prior to incarceration. Participants completed four surveys (baseline in prison and three-follow-up either in the community or in prison over 24 months) which were linked to state-wide hospital admissions and corrections data, 2014-2022. We estimated the crude incidence rate of hospitalisations for IRID (primary and non-primary diagnoses) and examined incidence in and out of prison.

Results: There were 181 hospitalisations with an IRID diagnosis (12.7% of all hospitalisations in the cohort) among 98 unique participants. Most were for skin and soft tissue infections (73%), followed by sepsis (23%; diagnoses were not mutually exclusive). Overall IRID incidence rate was 59.2 per 1000 person-years (PY) (95%CI=51.4-68.2), and 14.2 (95%CI=8.3-24.4) and 78.4 (95%CI=67.8-90.6) per 1000 PY during time in and out of prison, respectively. Incidence risk was substantially reduced in prison (incidence rate ratio [IRR]=0.2; 95%CI=0.1-0.3; p<0.001) compared to time in the community.

This was similar for the risk of any invasive infections (IRR=0.1; 95%CI=0.0-0.3; p<0.001) and skin and soft tissue infections (IRR=0.2; 95%CI=0.1-0.4; p<0.001).

Conclusion: The incidence of hospitalisations with IRID among this cohort was exceptionally high during time spent in the community.

Disclosure of interest: None to declare

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