Incarceration rates linked to elevated risk for premature death

Increased incarceration rates in counties across the U.S. were linked to increased risk for mortality from infectious diseases, chronic lower respiratory disease, substance abuse, suicide and multiple other causes, according to research published in Lancet Public Health.

“Our findings underscore public health benefits of reducing jail incarceration and the importance of interventions to mitigate the harmful effects of mass imprisonment on community health, including community-based treatment for substance use disorder and greater investment in social services,” Sandhya Kajeepeta, a PhD candidate in the department of epidemiology at Columbia Mailman School of Public Health, said in a press release.

Kajeepeta and colleagues conducted a retrospective, longitudinal study using data on U.S. county-level incarceration from 1987 to 2017 from the Vera Institute of Justice, and data on cause-specific mortality in people aged younger than 75 years from 1988 to 2018 collected from the U.S. National Vital Statistics System.

Models for nine causes of mortality were created and controlled for county-level, time-varying cofounders and stable characteristics, including median age, poverty rate, percentage of Black residents, crime rate, unemployment rate and state incarceration rate. The researchers lagged incarceration rate by 1 year in models to evaluate the short-term risk for premature death associated with incarceration rate, by 5 years to evaluate the medium-term risk, and by 10 years to evaluate the long-term risk.

A total of 1,094 counties — 36% of all counties in the U.S. — had at least 2 years of data available for the causes of death evaluated in the study.

According to the researchers, a 1 per 1,000 within-county increase in incarceration rate was associated with a 6.5% increase in death from infectious diseases (RR = 1.065; 95% CI, 1.061-1.07), a 4.9% increase in death from chronic lower respiratory diseases (RR = 1.049; 95% CI, 1.045-1.052), a 2.6% increase in death from substance use (RR = 1.026; 95% CI, 1.020-1.032) and a 2.5% increase in death from suicide (RR = 1.025; 95% CI, 1.020-1.029) after 1 year.

Kajeepeta and colleagues also identified smaller increases in death from heart disease (RR = 1.021, 95% CI, 1.019-1.023), unintentional injury (RR = 1.015; 95% CI, 1.011-1.018), malignant neoplasm (RR = 1.014; 95% CI, 1.013-1.016), diabetes (RR = 1.013; 95% CI, 1.009-1.018) and cerebrovascular disease (RR = 1.01; 95% CI, 1.007-1.013) 1 year after a 1 per 1,000 within-county increase in incarceration rate.

According to the researchers, the associations between incarceration and cause-specific mortality rates weakened over time as time lags increased to 5 and 10 years, more so for causes such as infectious diseases and suicide, which have shorter latency periods, than for causes like heart disease and cerebrovascular disease, which typically have longer latency periods.

“Our findings provide further evidence of the population-level public health harms of mass incarceration,” Kajeepeta said in the press release. “With U.S. correctional facilities reporting some of the highest COVID-19 infection rates in the nation, the pandemic highlights the immediate need for decarceral strategies to massively reduce the number of people held in our nation’s jails and prisons to protect the lives of incarcerated people and control infectious disease spread in the community.”

References:

Columbia. Incarceration Is Strongly Linked with Premature Death in U.S. https://www.publichealth.columbia.edu/public-health-now/news/incarceration-strongly-linked-premature-death-us. Accessed March 1, 2021.

Kajeepeta S, et al. Lancet Public Health. 2021;doi:10.1016/S2468-2667(20)30283-8.