Assessing the Mortality Impact of the COVID-19 Pandemic in Florida State Prisons

Abstract

Background The increased risk of COVID-19 infection among incarcerated individuals due to environmental hazards is well known and recent studies have highlighted the higher rates of infection and mortality prisoners in the United States face due to COVID-19. However, the impact of COVID-19 on all-cause mortality rates in incarcerated populations has not been studied. Methods Using data reported by the Florida Department of Corrections on prison populations and mortality events we conducted a retrospective cohort study of all individuals incarcerated in Florida state prisons between 2015 and 2020. We calculated excess deaths by estimating age-specific expected deaths from mortality trends in 2015 through 2019 and taking the difference between observed and expected deaths during the pandemic period. We calculated life table measures using standard demographic techniques and assessed significant yearly changes using bootstrapping. Findings The Florida Department of Corrections reported 510 total deaths from March 1, 2020 to December 31, 2020 among the state prison population. This was 42% higher (rate ratio 1.42, 95% CI 1.15 to 1.89) than the expected number of deaths in light of mortality rates for previous years. Reported COVID-19 deaths in a month were positively correlated with estimated excess deaths (80.4%, p <.01). Using age-specific mortality estimates, we found that life expectancy at age 20 declined by 4 years (95% CI 2.06-6.57) between 2019 and 2020 for the Florida prison population. Interpretation The Florida prison population saw a significant increase in all-cause mortality during the COVID-19 pandemic period, leading to a decrease in life expectancy of more than four years. Life years lost by the Florida prison population were likely far greater than those lost by the general United States population, as reported by other studies. This difference in years lost highlights the need for increased interventions to protect vulnerable incarcerated populations during pandemics. Funding Vital Projects Fund, Arnold Ventures, US Centers for Disease Control

The Risk of COVID-19 Infection in Prisons and Prevention Strategies: A Systematic Review and a New Strategic Protocol of Prevention

“…Finally, all of the included studies stated that the risk of COVID-19 infection in prisons was higher than in the general population, thus, prevention measures were needed to reduce the risk of transmission. In fact, Marquez, N.M. et al [ 31 ] calculated a mortality in 2020 that was 42% higher than that of 2019, of which 80.4% was due to COVID-19. Jiménez, M.C.…”

“…[ 19 ] tested some Canadian prisoners through swabs by PCR analysis for SARS-CoV-2 and found 29% positives compared with 6% of the general population (non-prisoners); mortality was 0.6%. Marquez et al [ 31 ], on the other hand, through a retrospective cohort study using data reported by the Florida Department of Corrections, stated that, comparing mortality in prisons from 2015 to 2019 with that of 2020, mortality in 2020 was 42% higher, with 80.4% deaths related to COVID-19.…”

“…A total of 1250 articles did not meet the inclusion criteria. Therefore, 21 articles were included in the present systematic review ( Figure 1 ) [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Excess mortality in U.S. prisons during the COVID-19 pandemic

“…Not only are incarcerated people more vulnerable to COVID-19 (3,4), but COVID-19 policies in prisons may have exacerbated risk of death from other causes (2,15,16). Therefore, all-cause mortality rates among incarcerated people likely increased during the pandemic, as a result of both COVID-19 infection and pandemicrelated changes that transformed the confinement experiences of incarcerated people.…”

“…Second, prisons faced unprecedented constraints on their staff and their medical resources, limiting access to routine primary and specialty medical care and delaying the timely delivery of care (20), exacerbating the risk of deaths due to natural causes, including but not limited to COVID-19. Third, prisons imposed policies attempting to mitigate infection-such as lockdowns and restricted movements, programming suspensions, visitor prohibitions, limited communication with loved ones, and solitary confinement in lieu of medical isolation-all of which increased stress, mental health challenges, and violence (2,15,16,20,21,22,23), exacerbating the risk of deaths due to unnatural causes, such as drug overdoses, suicide, and violence.…”