Khatri Utsha G, Hakes Jahn K, Buckler David, Zebrowski Alexis, Winkelman Tyler
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
US Census Bureau, Suitland, Maryland.
JAMA Netw Open. 2025 Jun 2;8(6):e2513537. doi: 10.1001/jamanetworkopen.2025.13537.
The US has the highest incarceration rates in the developed world. The harms of incarceration have long-term health implications, including increased mortality. Existing studies of incarceration-related mortality are limited by data sources and design.
To examine the associations between both individual- and area-level incarceration rates with all-cause and overdose mortality in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Mortality Disparities in American Communities (MDAC) study, linking over 3 million 2008 American Community Survey (ACS) respondents to National Death Index data from the respondents' 2008 interview date through December 31, 2019, or their date of death, and county incarceration data from the Vera Institute of Justice. The sample included US adults 18 years or older, representing individuals in group quarters such as prisons and jails but excluding those in counties lacking jail incarceration rate data. Data were analyzed from July 5, 2023, to November 10, 2024.
Individual incarceration status at the time of the ACS survey and county jail incarceration rates.
The outcomes of interest were all-cause mortality and overdose mortality, assessed through time-to-event analyses. Cox proportional hazard models were used to estimate mortality risks, adjusting for individual- and county-level characteristics. ACS survey weights were applied so that the final sample represents the US adult population.
The study includes a total of 3 255 000 individuals (51.3% female), of whom 45 000 (0.93%) were incarcerated at the time of the 2008 ACS administration. The mean (SD) county jail incarceration rate was 372 (358) per 100 000 people. During the study period, 431 000 individuals (11.6%) died from any cause, and 5500 (0.2%) died from overdoses. Incarcerated individuals had a higher risk of all-cause mortality (hazard rate [HR], 1.39 [95% CI, 1.33-1.45]) and an increased risk of overdose mortality (HR, 3.08 [95% CI, 2.70-3.52]) compared with nonincarcerated individuals. A 10% increase in county jail incarceration rates was associated with 4.6 (95% CI, 3.8-5.5) additional all-cause deaths per 100 000 people.
In this cohort study of 3.26 million individuals in the US, results highlighted the dual burden of incarceration on health outcomes. Individuals who were incarcerated faced significantly higher risks of death, particularly from overdoses, and elevated county incarceration rates exacerbated individual-level mortality risks. These findings suggest the need for reforms in criminal justice and public health policies to address these elevated risks and their widespread implications.
美国的监禁率在发达国家中是最高的。监禁的危害对健康有长期影响，包括死亡率上升。现有的关于监禁相关死亡率的研究受到数据源和设计的限制。
研究美国个人层面和地区层面的监禁率与全因死亡率和药物过量死亡率之间的关联。
设计、背景和参与者：这项队列研究使用了美国社区死亡率差异（MDAC）研究的数据，将超过300万2008年美国社区调查（ACS）的受访者与从受访者2008年访谈日期至2019年12月31日或其死亡日期的国家死亡指数数据，以及维拉司法研究所的县监禁数据相链接。样本包括18岁及以上的美国成年人，代表监狱和看守所等集体居住场所的人员，但不包括缺乏监狱监禁率数据的县的人员。数据于2023年7月5日至2024年11月10日进行分析。
ACS调查时的个人监禁状况和县监狱监禁率。
感兴趣的结局是全因死亡率和药物过量死亡率，通过事件发生时间分析进行评估。使用Cox比例风险模型估计死亡风险，并对个人层面和县级特征进行调整。应用了ACS调查权重，以使最终样本代表美国成年人口。
该研究共纳入325.5万人（51.3%为女性），其中4.5万人（0.93%）在2008年ACS调查时被监禁。县监狱监禁率的均值（标准差）为每10万人372人（358人）。在研究期间，43.1万人（11.6%）死于任何原因，5500人（0.2%）死于药物过量。与未被监禁的个体相比，被监禁个体的全因死亡风险更高（风险比[HR]，1.39[95%置信区间，1.33 - 1.45]），药物过量死亡风险增加（HR，3.08[95%置信区间，2.70 - 3.52]）。县监狱监禁率每增加10%，每10万人中就会增加4.6例（95%置信区间，3.8 - 5.5）全因死亡。
在这项对美国326万人的队列研究中，结果突出了监禁对健康结局的双重负担。被监禁的个体面临着显著更高的死亡风险，尤其是药物过量死亡风险，而县监禁率的升高加剧了个体层面的死亡风险。这些发现表明需要对刑事司法和公共卫生政策进行改革，以应对这些升高的风险及其广泛影响。
