Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study

• Published in: PloS one 2020-01, Vol.15 (1), p.e0227588-e0227588
• Main Authors: Kouyoumdjian, Fiona G, Lee, Ji Yun, Orkin, Aaron M, Cheng, Stephanie Y, Fung, Kinwah, O'Shea, Tim, Guyatt, Gordon
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory care; Canada; Chronic illnesses; Cohort analysis; Cohort Studies; Correctional institutions; Criminal sentences; Data bases; Discharge; Emergency medical care; Female; Health insurance; Health services; Hospitalization; Hospitals; Humans; Imprisonment; Kaplan-Meier Estimate; Male; Medicine; Medicine and Health Sciences; Mental health; Middle Aged; Morbidity; Mortality; Ontario; Patient Discharge; Patient Readmission - statistics & numerical data; Patient Readmission - trends; People and places; Population; Pregnancy; Primary care; Prisoners - psychology; Prisoners - statistics & numerical data; Prisons; Public health; Quality; Retrospective Studies; Social classes; Social interactions; Social Sciences; Social status
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227588

We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4-10.9) for people in prison and 6.9% (95%CI 5.5-8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41-1.27) for people in prison and 0.78 (95%CI 0.60-1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40-1.37) for people in prison and 0.48 (95%CI 0.36-0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access.