Mortality and causes of deaths in prisons in Rio de Janeiro, Brazil

Abstract: Mortality in prisons, a basic indicator of the right to health for incarcerated persons, has never been studied extensively in Brazil. An assessment of all-cause and cause-specific mortality in prison inmates was conducted in 2016-2017 in the state of Rio de Janeiro, based on data from the Mortality Information System and Prison Administration. Mortality rates were compared between prison population and general population after standardization. The leading causes of death in inmates were infectious diseases (30%), cardiovascular diseases (22%), and external causes (12%). Infectious causes featured HIV/AIDS (43%) and TB (52%, considering all deaths with mention of TB). Only 0.7% of inmates who died had access to extramural health services. All-cause mortality rate was higher among prison inmates than in the state’s general population. Among inmates, mortality from infectious diseases was 5 times higher, from TB 15 times higher, and from endocrine diseases (especially diabetes) and cardiovascular diseases 1.5 and 1.3 times higher, respectively, while deaths from external causes were less frequent in prison inmates. The study revealed important potentially avoidable excess deaths in prisons, reflecting lack of care and exclusion of this population from the Brazilian Unified National Health System. This further highlights the need for a precise and sustainable real-time monitoring system for deaths, in addition to restructuring of the prison staff through implementation of the Brazilian National Policy for Comprehensive Healthcare for Persons Deprived of Freedom in the Prison System in order for inmates to fully access their constitutional right to health with the same quality and timeliness as the general population.

摘要：监狱死亡情况是被监禁者健康权的一项基本衡量指标，此前巴西尚未对其开展过广泛研究。本研究基于死亡信息系统（Mortality Information System）与监狱管理部门的数据，于2016至2017年在里约热内卢州针对监狱在押人员的全因死亡率及死因别死亡率开展了评估。经标准化处理后，本研究对比了监狱羁押人群与普通人群的死亡率。在押人员的主要死亡原因依次为传染病（30%）、心血管疾病（22%）以及外因性死亡（12%）。传染病类别中，人类免疫缺陷病毒/艾滋病（HIV/AIDS）占比43%，肺结核（TB）占比52%（统计所有提及肺结核的死亡病例）。仅0.7%的已故在押人员能够使用院外医疗服务。监狱在押人员的全因死亡率高于该州普通人群。在押人员中，传染病相关死亡率为普通人群的5倍，肺结核相关死亡率为15倍，内分泌疾病（尤以糖尿病为主）与心血管疾病相关死亡率分别为1.5倍与1.3倍；而外因性死亡在监狱在押人员中的发生频率更低。本研究揭示了监狱中大量可避免的超额死亡案例，反映出该群体缺乏医疗照护，且被排除在巴西统一国家卫生系统（Brazilian Unified National Health System）之外。这进一步凸显了构建精准且可持续的死亡实时监测系统的必要性，同时还需通过落实《巴西监狱系统被剥夺自由者全面医疗保健国家政策》，对监狱医护人员队伍进行重构，以确保在押人员能够如同普通人群一般，获得同等质量与时效的医疗服务，切实享有宪法赋予的健康权。