LeMasters Katherine, Ranapurwala Shabbar, Behne Michael Forrest, Duchesneau Emilie, Fliss Mike Dolan, Lao Jennifer, Brinkley-Rubinstein Lauren
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
BMJ Public Health. 2024 Feb 7;2(1):e000544. doi: 10.1136/bmjph-2023-000544. eCollection 2024 Jun.
Suicide is one of the leading causes of death in US prisons. Yet, administrative data lags years behind and reporting rarely accounts for differing age distributions between suicide rates between incarcerated and general populations. Our objective was to compare reported suicides rate among those incarcerated in federal prisons and the general population, accounting for age distributions, before and during the COVID-19 pandemic (2009-2020).
Using data from the Federal Bureau of Prison, Bureau of Justice Statistics and the Centers for Disease Control and Prevention WONDER database and a retrospective cohort study design, we estimated age-standardised mortality rates and standardised mortality ratios comparing observed suicide mortality among those incarcerated in federal prisons to the expected mortality if they experienced the same age-specific suicide rates as the general population. We tested for linear trends over calendar year in each population.
In federal prisons, 245 deaths were reported as suicides from 2009 to 2020 (5% of federal prison deaths). From 2009 to 2020, the observed suicide rate in prisons increased from 10.57 to 19.01 per 100 000 and the crude suicide rate in the general population increased from 15.41 to 17.26 per 100 000. After age standardisation, the observed suicide rate in prisons was lower than the suicide rate in the general population between 2009 and 2019, but surpassed it in 2020. In 2020, we observed 1.07 (95% CI: 0.74 to 1.57) times the number of suicides than we would expect if the prison population had the same age-stratified risk of suicide as the general population.
Increasing suicide mortality in prisons is a public health crisis. In 2020, the age-standardised suicide rate in prison surpassed that of the general population, despite the incarcerated population being under high surveillance. To improve public health, decarceration community-based mental healthcare are promising solutions. Additionally, there is an urgent need for improved cause of death reporting quality in prisons.
自杀是美国监狱中主要的死亡原因之一。然而，行政数据滞后数年，且报告很少考虑被监禁人群与普通人群自杀率之间不同的年龄分布情况。我们的目标是在2009 - 2020年新冠疫情之前及期间，比较联邦监狱中被监禁者与普通人群的报告自杀率，并考虑年龄分布情况。
利用联邦监狱管理局、司法统计局和疾病控制与预防中心的WONDER数据库的数据以及一项回顾性队列研究设计，我们估计了年龄标准化死亡率和标准化死亡比，将联邦监狱中被监禁者的观察到的自杀死亡率与如果他们经历与普通人群相同的年龄特异性自杀率时的预期死亡率进行比较。我们检验了各人群在历年中的线性趋势。
在联邦监狱中，2009年至2020年报告有245例死亡为自杀（占联邦监狱死亡人数 的5%）。2009年至2020年，监狱中的观察到的自杀率从每10万人1️⃣0.57例增至1️⃣9.01例，普通人群的粗自杀率从每10万人1️⃣5.41例增至1️⃣7.26例。年龄标准化后，2009年至2019年监狱中的观察到的自杀率低于普通人群的自杀率，但在2020年超过了普通人群。2020年，如果监狱人群具有与普通人群相同的年龄分层自杀风险，我们观察到的自杀人数是预期自杀人数的1️⃣07倍（95%可信区间：️⃣74至1️⃣57）。
监狱中自杀死亡率上升是一场公共卫生危机。2020年，尽管被监禁人群受到高度监视，但监狱中年龄标准化自杀率超过了普通人群。为改善公共卫生状况，减少监禁和基于社区的精神卫生保健是有前景的解决方案。此外，迫切需要提高监狱中死亡原因报告的质量。
