Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
University of Colorado School of Medicine, Denver.
JAMA Intern Med. 2021 Oct 1;181(10):1315-1321. doi: 10.1001/jamainternmed.2021.4392.
COVID-19 incidence and mortality are higher among incarcerated persons than in the general US population, but the extent to which prison crowding contributes to their COVID-19 risk is unknown.
To estimate the associations between prison crowding, community COVID-19 transmission, and prison incidence rates of COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This was a longitudinal ecological study among all incarcerated persons in 14 Massachusetts state prisons between April 21, 2020, and January 11, 2021.
The primary exposure of interest was prison crowding, measured by (1) the size of the incarcerated population as a percentage of the prison's design capacity and (2) the percentage of incarcerated persons housed in single-cell units. The analysis included the weekly COVID-19 incidence in the county where each prison is located as a covariate.
The primary outcome was the weekly COVID-19 incidence rate as determined by positive SARS-CoV-2 tests among incarcerated persons at each prison over discrete 1-week increments.
There was on average 6876 people incarcerated in 14 prisons during the study period. The median level of crowding during the observation period ranged from 25% to 155% of design capacity. COVID-19 incidence was significantly higher in prisons where the incarcerated population was a larger percentage of the prison's design capacity (incidence rate ratio [IRR] per 10-percentage-point difference, 1.14; 95% CI, 1.03-1.27). COVID-19 incidence was lower in prisons where a higher proportion of incarcerated people were housed in single-cell units (IRR for each 10-percentage-point increase in single-cell units, 0.82; 95% CI, 0.73-0.93). COVID-19 transmission in the surrounding county was consistently associated with COVID-19 incidence in prisons (IRR [for each increase of 10 cases per 100 000 person-weeks in the community], 1.06; 95% CI, 1.05-1.08).
This longitudinal ecological study found that within 14 Massachusetts state prisons, increased crowding was associated with increased incidence rates of COVID-19. Researchers and policy makers should explore strategies that reduce prison crowding, such as decarceration, as potential ways to mitigate COVID-19 morbidity and mortality among incarcerated persons.
在被监禁的人群中，新冠发病率和死亡率高于美国一般人群，但监狱拥挤程度对其新冠风险的影响程度尚不清楚。
评估监狱拥挤程度、社区新冠传播以及监狱新冠发病率之间的关联。
设计、地点和参与者：这是一项在 2020 年 4 月 21 日至 2021 年 1 月 11 日期间在马萨诸塞州 14 所州立监狱所有被监禁者中进行的纵向生态学研究。
主要关注的暴露因素是监狱拥挤程度，通过以下两个方面来衡量：（1）被监禁人口占监狱设计容量的百分比；（2）被监禁者居住在单人牢房单元的百分比。分析包括作为协变量的每个监狱所在地县的每周新冠发病率。
主要结果是根据每个监狱中被监禁者的每周新冠阳性检测结果确定的新冠发病率，以离散的 1 周增量为单位进行计算。
在研究期间，平均有 6876 人被监禁在 14 所监狱中。在观察期间，拥挤程度的中位数范围从设计容量的 25%到 155%。在囚犯占监狱设计容量比例更高的监狱中，新冠发病率显著更高（每增加 10 个百分点的发病率比值[IRR]，1.14；95%CI，1.03-1.27）。在关押更多囚犯的单人牢房单元的监狱中，新冠发病率较低（每增加 10 个百分点的单人牢房单元 IRR，0.82；95%CI，0.73-0.93）。周边县的新冠传播与监狱中的新冠发病率始终相关（每增加 100000 人-周每 100000 人中 10 例的社区病例的 IRR[增加量]，1.06；95%CI，1.05-1.08）。
这项纵向生态学研究发现，在马萨诸塞州的 14 所州立监狱内，拥挤程度的增加与新冠发病率的增加相关。研究人员和政策制定者应探索减少监狱拥挤程度的策略，例如减少监禁人数，这可能是减轻被监禁者新冠发病率和死亡率的一种方式。
