Sex differences in acute health service contact after release from prison in Australia: a data linkage study

Abstract

ObjectivesWomen released from prison typically experience worse health outcomes than their male counterparts. We examined sex differences in the patterns, characteristics, and predictors of acute health service contact (AHSC) (i.e. ambulance and/or emergency department use) after release from prison. Study designData linkage study. MethodsBaseline survey data from 1307 adults (21% women) within six weeks of expected release from prisons in Queensland, Australia (2008–2010) were linked prospectively with state-wide ambulance and emergency department, correctional, mental health, and death records. Crude and adjusted incidence rates and incidence rate ratios of AHSC were calculated overall and by sex. An Andersen–Gill model was fit to examine whether sex predicted AHSC. The interaction effect between sex and each model covariate was tested. ResultsThe crude incidence rates of AHSC after release from prison were 1.4 (95% confidence interval [CI]: 1.3–1.5) and 1·1 (95%CI: 1.1–1.2) per person-year for women and men, respectively. The relationship between perceived physical health–related functioning at the baseline and AHSC was modified by sex (P = 0·039). The relationship between perceived health-related functioning and AHSC also differed among women. Compared to women who perceived their physical health as fair or good at the baseline, women who perceived their physical health as poor were at greater risk of AHSC (hazard ratio = 2.4, 95%CI: 1.4–3·9, P = 0.001) after release from prison. ConclusionsAmong people released from prison, women's and men's AHSC differs depending on how they perceive their own physical health. The specific needs of women and men must be considered in transitional support policy and planning to improve their health outcomes.