Examining COVID-19 Mortality Rates by Race and Ethnicity Among Incarcerated People in U.S. State Prisons

Abstract

Objective: To estimate coronavirus disease 2019 (COVID-19) mortality rates among individuals incarcerated in U.S. state prisons by race and ethnicity (RE). Design: Retrospective population-based analysis Setting: Data from state-level Departments of Corrections (DOCs) from March 1 through October 1, 2020. Participants: Publicly available data collected by Freedom of Information Act requests representing adults in the custody of US state DOCs. Main Outcomes: Cumulative COVID-19 death and custody population data. Crude RE-specific cumulative death rates per 1,000 persons, by state and in aggregate, using RE-specific custody population on March 1, 2020, as the denominator. Rate ratios (RR) and 95% confidence intervals (95%CI) compared state-level and aggregate cumulative age-adjusted mortality rates as of 10/01/2020 by RE, with White individuals as reference group. Results: Of all COVID-related deaths in U.S. prisons through October 2020, 23.35% (272 of 1165) were captured in our analyses. The average age at COVID-19 mortality was 63 years (SD=10 years) and was significantly lower among Black (60 years, SD=11 years) compared to White adults (66 years, SD=10 years; p<0.001). In age-standardized analysis, COVID-19 mortality rates were significantly higher among Black (RR=1.93, 95% CI: 1.25-2.99), Hispanic (RR=1.81, 95% CI: 1.10-2.96) and those of Other racial and ethnic groups (RR=2.60, 95% CI: 1.01-6.67) when compared to White individuals. Conclusions: Age-standardized mortality rates were higher among incarcerated Black, Hispanic and those of Other RE groups compared to their White counterparts. Greater data transparency from all carceral systems is needed to better understand populations at disproportionate risk of COVID-19 morbidity and mortality.