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Purpose of Review To critically appraise literature on recent advances and methods using “big data” to evaluate stroke outcomes and associated factors. Recent Findings Recent big data studies provided new evidence on the incidence of stroke outcomes, and important emerging predictors of these outcomes. Main highlights included the identification of COVID-19 infection and exposure to a low-dose particulate matter as emerging predictors of mortality post-stroke. Demographic (age, sex) and geographical (rural vs. urban) disparities in outcomes were also identified. There was a surge in methodological (e.g., machine learning and validation) studies aimed at maximizing the efficiency of big data for improving the prediction of stroke outcomes. However, considerable delays remain between data generation and publication. Summary Big data are driving rapid innovations in research of stroke outcomes, generating novel evidence for bridging practice gaps. Opportunity exists to harness big data to drive real-time improvements in stroke outcomes.

BACKGROUND The use of low dose CT (LDCT) chest is becoming more widespread in occupationally exposed populations. There is a knowledge gap as to heterogeneity in severity and the natural course of asbestosis after low levels of exposure. This study reports the characteristics of LDCT-detected interstitial lung abnormalities (ILA). METHODS The Asbestos Review Program offers annual LDCT, health assessments, and pulmonary function tests to an asbestos-exposed cohort. Asbestosis was defined using the Helsinki Consensus statement and the presence of ILA defined using a protocol for occupational CT reports. At least two of three pulmonary function tests: forced expiratory volume in 1 s (FEV1 );​ forced vital capacity (FVC); and diffusion capacity for carbon monoxide (DLco) were required for analysis of physiological decline. RESULTS From 1513 cases, radiological ILA was present in 485 (32%). The cohort was 83.5% male with a median age of 68.3 years and a median (IQR) asbestos exposure of 0.7 (0.09-2.32) fiber/ml-year. A mixed occupation, mixed asbestos fiber cohort comprised the majority of the cohort (65.8%). Of those with ILA, 40 (8.2%) had an FVC decline of ≥10% and 30 (6.2%) had a DLco decline of ≥15% per year. Time since first exposure, increasing tobacco exposure and reported dyspnea were independently associated with the presence of ILA. CONCLUSIONS In this population with relatively low asbestos exposure, LDCT-detected ILA that fits criteria for asbestosis is common, but physiological decline is not. This mild chronic stable phenotype of asbestos-associated ILA contrasts with the traditionally accepted views that asbestosis requires high exposures.

This study aimed to investigate the trends in colorectal cancer (CRC) incidence and mortality rates among the Western Australian (WA) population. This study further compared the trends with the timing of the implementation and rollout of the National Bowel Cancer Screening Program (NBCSP) and examined the survival predictors in CRC cases. This study was a whole-population, retrospective longitudinal study and included all individuals with a confirmed histological diagnosis of primary invasive CRC diagnosed in WA from 1990 to 2014 (n = 25,932). The temporal trends were assessed by Joinpoint regression models and Kaplan-Meier survival curves were used to asses 5-year survival. Predictors of survival were examined using multivariable Cox proportional hazard regression models, adjusting for age of diagnosis. The overall CRC incidence showed an upward trend between 1990 and 2010 (annual percent change (APC) = 1.1%); then, there was a downward trend from 2010 to 2014 (APC = − 5.0%). In younger people (< 50 years), the incidence rate increased steadily (APC = 0.9%) over the study period. The overall CRC mortality trend increased from 1990 to 1999 (APC = 1.6%), decreasing after that (APC = − 2.1%). Younger people had better CRC-related 5-year survival than older people (HR = 0.81, 95%CI 0.75–0.87, p = < 0.001). This study found that CRC incidence and mortality rates decreased among older people over the last 10 years in Western Australia. However, incidence continues to rise for younger people. Hence, more widespread adoption of the screening program, and potential preventive and early diagnostic strategies should become key priorities for the CRC control in WA.

To critically appraise literature on recent advances and methods using "big data" to evaluate stroke outcomes and associated factors.Recent big data studies provided new evidence on the incidence of stroke outcomes, and important emerging predictors of these outcomes. Main highlights included the identification of COVID-19 infection and exposure to a low-dose particulate matter as emerging predictors of mortality post-stroke. Demographic (age, sex) and geographical (rural vs. urban) disparities in outcomes were also identified. There was a surge in methodological (e.g., machine learning and validation) studies aimed at maximizing the efficiency of big data for improving the prediction of stroke outcomes. However, considerable delays remain between data generation and publication. Big data are driving rapid innovations in research of stroke outcomes, generating novel evidence for bridging practice gaps. Opportunity exists to harness big data to drive real-time improvements in stroke outcomes.

Background Diesel engine exhaust (DEE) is classified as a potential carcinogen for bladder cancer in humans by the International Agency for Research on Cancer. We aimed to compare bladder cancer incidence in Western Australian miners against the general population and determine if there was an association with DEE, measured as Elemental Carbon. Methods A whole-of-population cohort of 218,846 Western Australian miners employed during 1996-2013 was followed-up until June-2017. DEE exposure data was derived from work histories and collated with administrative State-wide cancer and death data. Standardised Incidence Ratios (SIRs) were calculated to compare rates with the general population. A nested case-control study design with matching on attained age was used. Conditional logistic regression was done to calculate Odds Ratios (ORs) for cumulative Elemental Carbon exposure (unlagged and 15-year lagged), after adjusting for smoking pack-years. Results Ninety cases (88 males) were observed and 180,377 controls selected. Miners had lower bladder cancer incidence than the general population (Observed=90; Expected=135.60; SIR:0.66, 95%CI:0.53-0.80). Within miners, DEE exposure was not found to be statistically significantly associated with bladder cancer (unlagged: OR = 0.75, 95%CI: 0.43-1.31; and 15-year lagged: OR = 0.59, 95%CI:0.25-1.40), after adjusting for smoking pack-years (unlagged and lagged OR:1.02, 95%CI:1.01-1.03). Conclusions Miners had lower risk of bladder cancer than the general population. DEE exposure was not associated with bladder cancer in this nested case-control study of contemporary Western Australian miners. Key messages Diesel engine exhaust was not found to be associated with bladder cancer in miners.

The Wittenoom crocidolite (blue asbestos) mine and mill ceased operating in 1966. The impact of this industry on asbestos-related disease in Western Australia has been immense. Use of the employment records of the Australian Blue Asbestos Company and records of the Wittenoom township residents has permitted two cohorts of people with virtually exclusive exposure to crocidolite to be assembled and studied. Follow-up of these two cohorts has been conducted through data linkage with available hospital, mortality and cancer records. The evolution of asbestos-related disease has been recorded and, with the establishment of exposure measurements, quantitative exposure–response relationships have been estimated. There has been an ongoing epidemic of mortality from lung cancer and malignant mesothelioma and, less so, from asbestosis. Wittenoom crocidolite was used extensively in asbestos-cement products in Western Australia. As a result, the state has recorded a higher malignant-mesothelioma mortality rate than in any other Australian state and in any defined general population in the world. Thus, the legacy of Wittenoom has extended beyond the mine and the town, and is still evident more than 50 years after the closure of the mine.

Metabolites of polycyclic aromatic hydrocarbons measured in human samples are often used as biomarkers of exposure to diesel engine exhaust (DEE). The aim of this study was to assess the changes in urinary levels of 1-aminopyrene (1-AP) and 1-hydroxypyrene (1-OHP) and their relationship with Elemental Carbon (EC), as a component of diesel engine exhaust exposure, among a hard-rock gold-mining population. Urine samples were collected at the beginning and end of a 12-hour work shift from 100 underground and above ground gold miners. Miners were fitted with personal exposure monitoring equipment to quantify exposure to DEE, measured as Elemental Carbon (EC), across their 12-hour work shift. General linear regression assessed associations of the post-shift urinary 1-AP and 1-OHP concentrations with EC, controlling for age, gender, the pre-shift biomarker level, Body Mass Index (BMI), days on current shift, time in mining, smoking status and second-hand smoke exposure. The concentrations of 1-AP and 1-OHP increased significantly across a 12-hour mining work shift. Moreover, consistent with the sensitivity analysis, the concentration of 1-AP was significantly associated with EC after adjustments. Urinary 1-OHP, but not 1-AP was significantly associated with current smoking. Urinary 1-AP may be a more robust and specific biomarker of DEE than 1-OHP.

Previous studies have reported that miners (and other workers) exposed to high levels of diesel engine exhaust (DEE) have an increased risk of lung function decline. The main objective of this study was to evaluate associations between exposure to different components associated with DEE in relation to lung function across a 12-h working shift. Eighty underground gold miners and twenty surface miners completed spirometry and questionnaires at the beginning and end of their 12 h work shift. Personal exposure to elemental carbon (EC), volatile organic compounds (VOCs), nitrogen dioxide (NO2), particle size and particle number were monitored during their shift. Multiple regression models were used to examine the associations between DEE and lung function, adjusting for a range of covariates. Underground miners were exposed to higher levels of EC, VOCs, NO2, and particle number and larger mean particle size than surface miners. Cross-shift reduction in Z-score value of FEV1/FVC in underground miners was statistically significantly greater than those of surface miners. The cross-shift change in Z-score value of FEV1/FVC was associated with exposure to higher concentration of EC and particle number, but not with VOCs, NO2 and particle size. Occupational exposure to diesel engine exhaust in current Australian gold mines is substantial. Exposures were higher in underground miners and had a negative association with their lung function over a single 12-h shift.

Objectives An asbestos job-exposure matrix (AsbJEM) has been developed to systematically and cost-effectively evaluate occupational exposures in population-based studies. The primary aim of this study was to examine the accuracy of the AsbJEM in determining exposure–response relationships between asbestos exposure estimates and malignant mesothelioma (MM) incidence (indirect validation). The secondary aim was to investigate whether the assumptions used in the development of the original AsbJEM provided accurate asbestos exposure estimates. Methods The study population consisted of participants in an annual health surveillance program, who had at least 3-month occupational asbestos exposure. Calculated asbestos exposure indices included cumulative asbestos exposure and the average exposure intensity, estimated using the AsbJEM and duration of employment. Asbestos and MM exposure–response relationships were compared between the original AsbJEM and its variations based on manipulations of the intensity, duration and frequency of exposure. Twenty-four exposure estimates were calculated for both cumulative asbestos exposure and the average exposure intensity using three exposure intensities (50th, 75th and 90th percentile of the range of mode exposure), four peak durations (15, 30, 60 and 120 min) and two patterns of peak frequency (original and doubled). Cox proportional hazards models were used to describe the associations between MM incidence and each of the cumulative and average intensity estimates. Results Data were collected from 1602 male participants. Of these, 40 developed MM during the study period. There were significant associations between MM incidence and both cumulative and average exposure intensity for all estimates. The strongest association, based on the regression-coefficient from the models, was found for the 50th percentile of mode exposure, 15-min peak duration and the doubled frequency of peak exposure. Using these assumptions, the hazard ratios for mesothelioma were 1 (reference), 1.91, 3.24 and 5.37 for the quartiles of cumulative asbestos exposure and 1 (reference), 1.84, 2.31 and 4.40 for the quartiles of the average exposure intensity, respectively. Conclusion The well-known positive exposure–response relationship between MM incidence and both estimated cumulative asbestos exposure and average exposure intensity was confirmed. The strongest relationship was found when the frequency of peak exposure in the AsbJEM was doubled from the originally published estimates.

Information on older offenders’ mental health service (MHS) used before and after sentence is sparse. We therefore aimed to determine the 1-year prevalence of MHS use before sentence, and the likelihood and predictors of MHS use in the 5-year post-sentence period by first-time older adult offenders (≥45 years). Pre- and post-sentence MHS use by a cohort of 1,853 first-time offenders over 45 years in Western Australia was determined through whole-population linked administrative data. Logistic regression models compared the 1-year pre-sentence MHS contacts between offenders and matched non-offenders. Cox proportional hazards regression models identified the socio-demographic, offending and pre-sentence health service variables that determined post-sentence MHS use. Older offenders were six times more likely to have used MHSs than non-offenders before sentence. Substance use was the most commonly treated disorder. Non-custodial offenders were twice more likely than prisoners to have been treated for any mental disorder and substance use disorders, and violent offenders were four times more likely to have attempted self-harm than non-violent offenders before being sentenced. The strongest predictors of post-sentence MHS contact were past psychiatric diagnosis in offenders with a pre-sentence MHS contact, and pre-sentence hospitalisation for attempted self-harm or physical illness, or being a male in those without. Discontinuity in MHS use after sentence by over half of the offenders with a prior contact was prominent. Better detection and treatment of mental disorders in older offenders to ensure continuity of care at all transition points through age-sensitive correctional and community-based MHSs is needed.

BACKGROUND: Little is known about whether or how offenders use mental health services after sentence completion. AIM: This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables. METHODS: Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use. RESULTS: The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use. CONCLUSIONS: Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders. Copyright © 2014 John Wiley & Sons, Ltd. Language: en

With the high risk of death associated with mental disorders and their increased prevalence in offenders, it is judicious to investigate the risk of post-sentence mortality with respect to offenders’ psychiatric treatment history. Using linked administrative data for a whole-population retrospective cohort of first-time adult offenders (n = 25,537) sentenced to either prison or non-custodial orders in Western Australia, we determined the risk and baseline predictors of post-sentence mortality. Of 192 deaths within 2 years of sentence completion, deaths from injury/poisoning (55.6 %), cancer (13.3 %) and cardiovascular disorders (9.7 %) were the most common. Pre-sentence history of mental health service (MHS) contact doubled the risk of post-sentence all-cause and injury/poisoning-related mortality. Physical comorbidity was the strongest predictor of mortality irrespective of pre-sentence MHS contact. Baseline history of attempted self-harm and being an Indigenous male were associated with an elevated risk of death in offenders with a pre-sentence MHS contact. In offenders without a pre-sentence MHS contact, socio-economic disadvantage and incarceration almost doubled the risk of dying from any cause and injury/poisoning. Mortality risk in the 2 years following sentence completion is associated with pre-sentence health service use and a range of socio-demographic factors for both incarcerated and non-custodial offenders. The opportunity afforded by imprisonment could be exploited by provision of funding to identify and treat mental illness, impart preventive health education addressing modifiable risk factors and provide transitional care to community-based services, all of which may help reduce preventable post-sentence deaths. Diversion to non-custodial sentences is also a plausible option.

ObjectivesMining is associated with exposures to various lung carcinogens such as diesel engine exhaust (DEE) and respirable crystalline silica (RCS). We aimed to determine if lung cancer incidence was higher in Western Australian (WA) miners than the general population and if risk varied within the cohort according to exposures and work or job types.MethodsExposure data for 1 72 398 miners living and working in WA between 1996 and 2013 was combined with administrative WA cancer and death data until June-2017. Causal Incidence Ratios (CIRs) were calculated for general population comparisons. Hazard Ratios (HRs) were derived from multivariable Cox regression models including sex, only-underground work, ore-type (gold, iron-ore, other metal, non-metal, unknown or multi-ore mines) and quantitative estimates of DEE (measured as elemental carbon) and RCS, after adjusting for ever-smoker status and entry-age. Additional analyses were done after lagging exposures by 15 years.ResultsMean DEE and RCS cumulative exposures were estimated as 0.15 mg/m3-years (std:0.37) and 0.09 mg/m3-years (std:0.18), respectively. Miners had lower lung cancer incidence than the general population (observed=382; expected=538.11; CIR:0.71, 95% CI:0.64–0.78). Within the mining cohort, higher lung cancer risks were observed for: females vs. males (HR:1.44, 95% CI:0.97–2.03); ever-smokers vs. never-smokers (HR:10.1, 95% CI:6.37–16.1); only-underground vs. only-surface miners (HR:1.72, 95% CI:1.02–2.90); only gold vs. multi-ore miners (HR:1.44, 95% CI:1.01–2.05); and only iron ore vs. multi-ore miners (HR:1.47, 95% CI:1.07–2.04). Neither DEE (HR:1.01, 95% CI:0.89–1.14) nor RCS (HR:0.89, 95% CI:0.61–1.3) was significantly associated with incidence. There was no significant difference in estimates after lagging exposures.ConclusionMiners had lower risk of lung cancer than the general population. Workers mining exclusively in underground, iron ore or gold mines had higher lung cancer risks than their peers, as did ever-smokers and females. Low levels of DEE and RCS exposures in WA mines may explain the lack of association between these exposures and lung cancer.

BACKGROUND: Little is known about community mental health service use prior to offending. AIM: This study aimed to investigate the 1-year community mental health service use by adult offenders (18-44 years) prior to their first ever criminal sentence in Western Australia. METHODS: Administrative mental health service data were compared between all offenders (n = 23,755) commencing their first ever criminal sentence in Western Australia during 1985-1994 and a matched community group of 21,977 non-offenders. RESULTS: Just over 8% of offenders had used mental health services prior to sentence compared with 1% of non-offenders. After adjusting for age, offenders were more likely to have used these services than non-offenders in all gender-race groups, but the effect was strongest for non-Indigenous women, who were over 12 times more likely to have used such services, and weakest among Indigenous men, who were about twice as likely to have used them as their non-offending peers. Service use for substance use disorder, the most common diagnosis, was about one and a half times more prevalent among Indigenous than non-Indigenous offenders, regardless of gender. For non-Indigenous offenders, prevalence of any mental health service contact was higher for violent than non-violent offenders, irrespective of gender. Service use was no different between offenders receiving custodial or non-custodial sentences in all gender-race groups. CONCLUSION: The higher likelihood of mental health service use by offenders in the year prior to their first ever sentence than by non-offenders suggests that, insofar as the disorder was relevant to offending, there were some opportunities for preventive measures during that time. Differential service use according to gender and Indigenous/non-Indigenous status is of concern. It would be important to understand more about this apparently unequal service access, not least because Indigenous populations tend to be over-represented in prison. Copyright © 2014 John Wiley & Sons, Ltd. Language: en

Objectives Miners are exposed to a range of hazards including injury risks and exposure to carcinogens and inorganic fibres and dusts. We aimed to assess miners’ mortality from all and specific causes, including accidents/injuries (intentional and unintentional), cancer, cardiovascular disorders (any, ischaemic heart disease and stroke) and respiratory disorders (any and chronic obstructive pulmonary disease), relative to the general population and identify subgroups at risk. Methods Registry data identified deaths in a cohort of 198,981 mineworkers (87% male, mean age: 34 ± 11 years) in Western Australia during 1996–2011. Indirectly standardised mortality ratios (SMRs) were calculated and multivariable Poisson models were used to evaluate ever-underground work, employment commencement year and employment tenure as predictors of mortality within miners after adjusting for age, sex, smoking, socioeconomic status and comorbidity. Results There were 2,156 miner deaths over 1,419,201 person-years. Cancer (n = 682, 31.6%), unintentional accidents/injuries (n = 678, 31.4%) and ischaemic heart disease (n = 303, 14.1%) were the leading causes of deaths. Compared with the general population, the specific and all-cause mortality rates were lower for both female (SMR: 0.71, 95% CI: 0.57–0.85) and male (SMR: 0.70, 95% CI: 0.67–0.73) miners. Within miners, higher all-cause mortality rates were observed for ever-smokers „(Mortality Rate Ratio (MRR): 1.83, 95% CI: 1.65–2.03) and those commencing employment before 1996 (MRR: 3.25, 95% CI: 2.82–3.75), than their counterparts. Increasing trends in mortality were associated with higher comorbidity scores (MRR: 2.51, 95% CI: 2.16–2.90), increasing socio-economic disadvantage (MRR: 1.16, 95% CI: 1.12–1.19) and reducing employment tenures (MRR: 1.77, 95% CI: 1.68–1.86). Similar patterns were observed for the specific causes of death. Ever-underground work was associated with higher, but non-significant, risk of unintentional accident/injury (MRR: 1.33, 95% CI: 0.99–1.79), cancer (MRR: 1.20, 95% CI: 0.90–1.60) and all-cause (IRR: 1.10, 95% CI: 0.95–1.28) deaths. Conclusion The lower overall death risk among miners compared with the general population may be explained by the healthy-worker effect and short follow-up. However, short-tenured miners, especially those with under 2.5-years of employment, had high comorbidity-adjusted mortality rates.

Objectives The mining industry is associated with exposures to a range of established and potential carcinogens (e.g. radiation and particulates from metals, crystalline silica, diesel exhaust, etc.). We aimed to assess the full spectrum of cancer incidence in miners relative to the general population and to identify specific subgroups at risk. Methods Cancer registry data identified cancer incidence in a cohort of 222,899 mine workers (87% male, mean age: 34 ± 11 years) in Western Australia during 1996–2013. Indirectly standardised incidence ratios (SIRs) were calculated and multivariable Poisson models were used to evaluate ever-underground work, employment commencement year and employment tenure as predictors of cancer incidence within miners after adjusting for age, sex, ever-smoker status and socioeconomic status. Results Among miners, 4,884 cancers over 1,826,498 person-years were identified. Both female (SIR: 0.81, 95% CI: 0.73–0.90) and male (SIR:0.89, 95% CI:0.87–0.92) miners had lower cancer incidence than the general population. Significantly greater risks were observed for cancers of the bones (SIR:2.10, 95% CI: 1.36–2.84), larynx (SIR: 1.42, 95% CI: 1.05–1.80) and melanoma (SIR: 1.16, 95% CI: 1.08–1.24) in males. Within miners, those commencing employment before 1996 had elevated risks for any cancer (Incidence Rate Ratio (IRR):1.11, 95% CI: 1.02–1.22) than their counterparts, in particular mesothelioma, brain, lung, liver and colorectal cancers. With the exception of testicular cancer (trend IRR: 1.27, 95% CI: 1.06–1.51), risks for mesothelioma and brain, bone, lung, pharyngeal, stomach, colorectal and any cancer (trend IRR: 0.92, 95% CI: 0.89–0.95) declined with increasing employment tenure. Ever working underground was positively associated with lung (IRR:1.60, 95% CI: 1.11–2.32) and renal (IRR: 1.79, 95% CI: 1.03–3.12) cancer. Conclusion The healthy worker effect possibly explains miners’ lower incidence of most cancers compared with the general population. Short-tenured and underground miners were at risk of certain cancers, not limited to the lung. Forthcoming studies will need to evaluate the role of mining exposures in these cancers in the occupational sub-groups.

Little is known about community mental health service use prior to offending.This study aimed to investigate the 1-year community mental health service use by adult offenders (18-44 years) prior to their first ever criminal sentence in Western Australia.Administrative mental health service data were compared between all offenders (n = 23,755) commencing their first ever criminal sentence in Western Australia during 1985-1994 and a matched community group of 21,977 non-offenders.Just over 8% of offenders had used mental health services prior to sentence compared with 1% of non-offenders. After adjusting for age, offenders were more likely to have used these services than non-offenders in all gender-race groups, but the effect was strongest for non-Indigenous women, who were over 12 times more likely to have used such services, and weakest among Indigenous men, who were about twice as likely to have used them as their non-offending peers. Service use for substance use disorder, the most common diagnosis, was about one and a half times more prevalent among Indigenous than non-Indigenous offenders, regardless of gender. For non-Indigenous offenders, prevalence of any mental health service contact was higher for violent than non-violent offenders, irrespective of gender. Service use was no different between offenders receiving custodial or non-custodial sentences in all gender-race groups.The higher likelihood of mental health service use by offenders in the year prior to their first ever sentence than by non-offenders suggests that, insofar as the disorder was relevant to offending, there were some opportunities for preventive measures during that time. Differential service use according to gender and Indigenous/non-Indigenous status is of concern. It would be important to understand more about this apparently unequal service access, not least because Indigenous populations tend to be over-represented in prison.

Little is known about whether or how offenders use mental health services after sentence completion.This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables.Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use.The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use.Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.