COVID-19 Incidence and Mortality in Federal and State Prisons Compared With the US Population, April 5, 2020, to April 3, 2021 | Infectious Diseases | JAMA | JAMA Network
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Figure.  Weekly COVID-19 Incidence Rates and Standardized Mortality Rates in US Prisons and in the Overall US Population From April 5, 2020, to April 3, 2021
Weekly COVID-19 Incidence Rates and Standardized Mortality Rates in US Prisons and in the Overall US Population From April 5, 2020, to April 3, 2021

Mortality rates are adjusted for age and sex. The incidence rate peaked for the prison population the week of December 13, 2020, while the mortality rate peaked the week of January 3, 2021, with values of 2327 new cases and 9.6 deaths per 100 000 individuals, respectively.

Table.  Demographic Characteristics and COVID-19 Statistics for the Overall US Population and Prison Population
Demographic Characteristics and COVID-19 Statistics for the Overall US Population and Prison Population
1.
Saloner  B, Parish  K, Ward  JA, DiLaura  G, Dolovich  S.  COVID-19 cases and deaths in federal and state prisons.   JAMA. 2020;324(6):602-603. doi:10.1001/jama.2020.12528 PubMedGoogle ScholarCrossref
2.
Dolovich  S. Mass incarceration, meet COVID-19. University of Chicago Law Review Online. Published November 16, 2020. Accessed April 10, 2021. https://ssrn.com/abstract=3766415
3.
Kang-Brown  J, Montagnet  C, Heiss  J. People in Jail and Prison in Spring 2021. Vera Institute of Justice. Published June 2021. Accessed June 15, 2021. https://www.vera.org/publications/people-in-jail-and-prison-in-2020
4.
National Academies of Sciences, Engineering, and Medicine.  Decarcerating Correctional Facilities During COVID-19: Advancing Health, Equity, and Safety. National Academies Press; 2020. doi:10.17226/25945
5.
Marshall Project. A state-by-state look at coronavirus in prisons. Accessed April 10, 2021. https://www.themarshallproject.org/2020/05/01/a-state-by-state-look-at-coronavirus-in-prisons
6.
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the US. Accessed June 15, 2021. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#SexAndAge
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    Douglas Jones, BS, MBA, MSHA | University of Alabama at Birmingham
    This study, while interesting and relevant, does not acknowledge or adjust for limitations which may in part explain the differences between the findings for the incarcerated population and the general population in the US.

    First, the prevalence of infectious diseases such as Hepatitis C, HIV, and tuberculosis is higher in correctional populations than in the general population, as is the prevalence of chronic conditions such as hypertension, diabetes, heart related conditions, kidney related conditions, asthma, and cirrhosis of the liver. (Maruschak, Berzofsky, & Unangst, 2015) Studies suggest that individuals with pre-existing comorbidities have a greater risk of mortality
    than individuals without comorbidities. (Ssentongo et al., 2020; Venkata & Kiernan, 2020; Williamson et. al, 2020)

    Second, studies have found prisoners experience the effects of aging sooner due to substance abuse, inadequate healthcare before and between incarcerations, and stress related to the prison environment. They are more likely to experience dementia, impaired mobility, loss of hearing and vision, and general vulnerability which precipitates collateral emotional and mental health problems. (Anno, 2001; Anno et al., 2004; Chiu, 2010; Travis, Western, & Redburn, 2014) Studies suggest that age and sex are predictors of mortality rates from COVID-19. (Bauer et. al, 2021; Yanez et. al, 2020)

    References

    Anno, B. J. (2001). Correctional Health Care: Guidelines for the Management of an Adequate Delivery System, 2001 edition. Chicago, IL: National Commission on Correctional Health Care.

    Anno, B. J., Graham, C., Lawrence, J. E., Shansky, R., Bisbee, J., & Blackmore, J. (2004). Correctional health care: Addressing the needs of elderly, chronically ill, and terminally ill inmates. Middletown, CT: Criminal Justice Institute.

    Bauer, P., Brugger, J., König, F. & Posch, M. (2021). An international comparison of age and sex dependency of COVID-19 deaths in 2020: a descriptive analysis. Scientific Reports 11, 19143. https://doi.org/10.1038/s41598-021-97711-8

    Chiu, T. (2010). It's about time: Aging prisoners, increasing costs and geriatric release: Vera Institute of Justice New York, NY.

    Maruschak, L. M., Berzofsky, M., & Unangst, J. (2015). Medical problems of state and federal prisoners and jail inmates, 2011-12. US Department of Justice, Office of Justice Programs, Bureau of Justice Related Statistics.

    Ssentongo, P., Ssentongo, A. E., Heilbrunn, E. S., Ba, D. M., Chinchilli, V. M. (2020). Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS ONE 15(8): e0238215. https://doi.org/10.1371/journal.pone.0238215

    Travis, J., Western, B., & Redburn, F. S. (2014). The growth of incarceration in the United States: Exploring causes and consequences.

    Venkata, V. S. & Kiernan, G. (2020). COVID-19 and COPD: Pooled analysis of observational studies. Chest 158(4): A2469. https://doi.org/10.1016/j.chest.2020.09.046

    Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. (2020) Factors associated with COVID-19-related death using OpenSAFELY. Nature 584, 430–436. https://doi.org/10.1038/s41586-020-2521-4

    Yanez, N. D., Weiss, N. S., Romand, J. A., Treggiari, M. M. (2020) COVID-19 mortality risk for older men and women. BMC Public Health 20(1):1742. doi: 10.1186/s12889-020-09826-8. PMID: 33213391; PMCID: PMC7675386.

    CONFLICT OF INTEREST: None Reported
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    Research Letter
    October 6, 2021

    COVID-19 Incidence and Mortality in Federal and State Prisons Compared With the US Population, April 5, 2020, to April 3, 2021

    Author Affiliations
    • 1University of Washington Department of Sociology, Seattle
    • 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 3Yale Law School, New Haven, Connecticut
    • 4University of California Los Angeles School of Law, Los Angeles
    JAMA. 2021;326(18):1865-1867. doi:10.1001/jama.2021.17575

    Early in the COVID-19 pandemic, case and death rates in US prisons substantially exceeded national rates.1 Prison systems subsequently reported adopting several policies to contain COVID-19 spread, including limiting social interactions, distributing personal protective equipment, and expediting prisoner releases,2,3 although failures of infection prevention and control have been documented.2,4 We examined COVID-19 cases and deaths among US federal and state prisoners during the first 52 weeks of the pandemic and compared these rates with the overall US population, updating a previously published report analyzing COVID-19 incidence and mortality in prisons through June 6, 2020.1

    Methods

    Counts of COVID-19 cases and deaths among prisoners in all 50 state prison systems and the Federal Bureau of Prisons were collected by the UCLA Law COVID Behind Bars Data Project for 52 weeks from April 5, 2020, to April 3, 2021. Counts were extracted from departments of corrections websites and, as needed, supplemented with data collected by the Marshall Project and the Associated Press.5 To calculate rates of COVID-19 in prisons, we used total jurisdictional prison population data reported by the Vera Institute3 for January 1, 2020, July 1, 2020, December 30, 2020, and March 31, 2021. We estimated weekly prison populations by linearly interpolating between the observed dates. For comparison, we also calculated US population COVID-19 rates using cases and deaths reported by the Centers for Disease Control and Prevention,6 allowing for a 2-month reporting delay. US population data were taken from the US Census Bureau’s American Community Survey 2019.

    We calculated both weekly and cumulative rates of incidence and standardized mortality for the prison population and US population. Weekly prison rates were calculated using the jurisdictional incarcerated population for the corresponding week, while cumulative rates were calculated using the 52-week mean population size. Standardized mortality rates were calculated, adjusting for age and sex with indirect standardization, as described in a previous report.1 All analysis was performed using R version 4.1.0. The UCLA institutional review board deemed this study to be exempt.

    Results

    By April 3, 2021, 394 066 COVID-19 cases and 2555 deaths due to COVID-19 had been reported among the US prison population (Table). The cumulative incidence rate per 100 000 persons was 30 780 cases for the prison population and 9350 cases for the US population, with a prison-to-US cumulative incidence ratio of 3.3 (95% CI, 3.3-3.3). The standardized mortality rate per 100 000 persons was 199.6 deaths for the prison population and 80.9 deaths for the US population (Table), with a prison-to-US standardized cumulative mortality rate ratio of 2.5 (95% CI, 2.3-2.7).

    The prison population weekly incidence rate peaked during the week of December 13, 2020, when there were 2327 new cases per 100 000 persons. The standardized mortality rate peaked during the week of January 3, 2021, with 9.6 new deaths per 100 000 persons (Figure). During these weeks, the prison-to-US incidence rate ratio was 5.0 (95% CI, 5.0-5.1), while the standardized mortality ratio was 2.7 (95% CI, 1.9-3.8).

    Discussion

    COVID-19 incidence and standardized mortality rates remained consistently higher among the prison population than the overall US population in the first year of the pandemic. While COVID-19 incidence and mortality rates peaked in late 2020 and early 2021 and have since declined, the cumulative toll of COVID-19 has been several times greater among the prison population than the overall US population.

    A study limitation is reliance on publicly available data, which are subject to potential misreporting, delays,4 and inconsistencies in population estimates.3 In addition, differences in testing rates between the overall US population and the prison population may have biased incidence ratios. Also, the study period did not capture the more recent outbreak of COVID-19 cases due to the Delta variant. Nevertheless, this study underscores the importance of initiatives such as vaccination, decarceration, and continued disease surveillance in prison settings as long as the pandemic continues.

    Section Editors: Jody W. Zylke, MD, Deputy Editor; Kristin Walter, MD, Associate Editor.
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    Article Information

    Corresponding Author: Neal Marquez, MPH, Los Angeles School of Law, UCLA Law COVID-19 Behind Bars Data Project, University of California, Los Angeles, 385 Charles E. Young Dr E, Los Angeles, CA 90095 (marquezn@law.ucla.edu).

    Accepted for Publication: September 16, 2021.

    Published Online: October 6, 2021. doi:10.1001/jama.2021.17575

    Author Contributions: Mr Marquez had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Marquez, Ward, Parish, Saloner.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Marquez, Ward.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Marquez, Saloner.

    Obtained funding: Dolovich.

    Administrative, technical, or material support: Parish.

    Supervision: Dolovich.

    Conflict of Interest Disclosures: Dr Saloner reported receiving personal fees from the University of Wisconsin and the Cambridge Health Alliance. No other disclosures were reported.

    Funding/Support: Mr Marquez and Dr Dolovich were funded by the Vital Projects Fund and Arnold Ventures. Mr Marquez was funded by a National Institute of Child Health and Human Development (NICHD) P2C grant (P2C HD042828). Ms Ward was funded by a NICHD T32 grant (T32-HD 094687). Dr Saloner was funded by a Greenwall Foundation Making a Difference grant. Dr Dolovich was funded by a Centers for Disease Control and Prevention contract.

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

    Additional Contributions: We acknowledge assistance from the UCLA Law COVID Behind Bars Data Project, whose researchers supervised data collection.

    References
    1.
    Saloner  B, Parish  K, Ward  JA, DiLaura  G, Dolovich  S.  COVID-19 cases and deaths in federal and state prisons.   JAMA. 2020;324(6):602-603. doi:10.1001/jama.2020.12528 PubMedGoogle ScholarCrossref
    2.
    Dolovich  S. Mass incarceration, meet COVID-19. University of Chicago Law Review Online. Published November 16, 2020. Accessed April 10, 2021. https://ssrn.com/abstract=3766415
    3.
    Kang-Brown  J, Montagnet  C, Heiss  J. People in Jail and Prison in Spring 2021. Vera Institute of Justice. Published June 2021. Accessed June 15, 2021. https://www.vera.org/publications/people-in-jail-and-prison-in-2020
    4.
    National Academies of Sciences, Engineering, and Medicine.  Decarcerating Correctional Facilities During COVID-19: Advancing Health, Equity, and Safety. National Academies Press; 2020. doi:10.17226/25945
    5.
    Marshall Project. A state-by-state look at coronavirus in prisons. Accessed April 10, 2021. https://www.themarshallproject.org/2020/05/01/a-state-by-state-look-at-coronavirus-in-prisons
    6.
    Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the US. Accessed June 15, 2021. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#SexAndAge
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