Mortality among people who had contact with the criminal justice system during adolescence: a systematic review and meta-analysis.

BACKGROUND

Young people who have contact with the criminal justice system are at increased risk of death compared to the general population. However, the evidence on this has never been systematically synthesised. This review examined the available evidence on mortality rates and associated risk factors in this population.

METHODS

We searched five academic databases for cohort studies reporting deaths that occurred following criminal justice system contact before 20 years of age. We collected data on deaths due to all-causes, non-communicable disease, communicable disease, accidental injury, alcohol and other drug-related causes, suicide, and homicide. We used random effects meta-analyses to estimate pooled crude mortality rates (CMRs) and standardised mortality ratios (SMRs) for each cause of death, overall and by sex. Incidence rate ratios (IRR) were pooled to compare mortality rates by sex. Risk factors for all-cause mortality were narratively synthesised.

RESULTS

Eleven studies from eight independent cohorts met review criteria, totalling 48,195 people and 1568 deaths observed. The pooled all-cause CMR was 418 per 100,000 person-years (95% CI: 301,580; I2 = 97%; k = 7). The pooled all-cause SMR was 5.9 (95% CI: 3.9,9.0; I2 = 99%; k = 6); 5.6 for males (95% CI: 3.5,8.9; I2 = 96%; k = 4), and 12.0 for females (95% CI: 4.8,29.7; I2 = 95%; k = 4). Pooled SMRs were also elevated for drug-related causes, suicide, and homicide. The rate of homicide mortality was lower for females than for males (IRRfemale/male = 0.4; 95% CI: 0.2,0.9; I2 = 97%; k = 2) and higher for drug-related causes (IRRfemale/male = 2.7; 95% CI: 1.1,6.4; I2 = 96%; k = 3). Mortality risk factors included being male, Black or Hispanic in the United States, increased severity of justice involvement, and repeat offending.

CONCLUSION

People who have contact with the criminal justice system during adolescence have an increased risk of dying prematurely, compared to the general population.