Association of Incarceration With Mortality by Race From a National Longitudinal Cohort Study

Abstract

Key Points Questions Is exposure to incarceration associated with a long-term increase in mortality rate, and does this association differ by race? Findings In this cohort study of 7974 individuals who were followed up from 1979 to 2018, incarceration was associated with a 65% higher mortality rate among Black participants. Among non-Black participants, incarceration was not associated with mortality. Meaning These findings suggest that racial disparities in the association of incarceration with mortality—as well as in rates of exposure to incarceration—may partially explain the lower life expectancy of the non-Hispanic Black population in the US.

Invited Perspective: Uncovering Harmful Exposures in Carceral Environments

“…Most epidemiological studies have measured incarceration simplistically as a binary or time-varying exposure to assess its health-related effects on individuals, families, and communities. 5 – 7 Due to a variety of barriers, public health research has insufficiently accounted for how conditions of confinement—the social and material conditions within carceral environments—contribute to health inequities. Furthermore, incarcerated people are largely excluded from national disease registries and population surveys that governments rely on to understand determinants of and mobilizing solutions to disparities.…”

Mass Incarceration and Inmate Mortality in the United States—Death by Design?

“…3 The criminal justice system is not only a "manifestation of structural racism," 1 but it also produces health disparities through the life-depleting effects experienced by Black individuals, rendering the carceral state a contributor to racial violence. Indeed, the slow death that both Ruch et al 2 and Bovell-Ammon et al 1 identify should be thought of in relation to other direct and brutal forms of anti-Black state violence that is so often committed by agents of the criminal justice system. 4 Moreover, it is precisely the dispersed and banal processes that render the mortality risks of incarceration so profoundly devastating, as they reflect the wearing down and utter exhaustion of life lived under regimes of racial violence.…”

“…Two complementary studies published in JAMA Network Open shed light on the association between incarceration and mortality (Bovell-Ammon et al and Ruch et al). Bovell-Ammon et al explore the association between incarceration and mortality using cohort data from the National Longitudinal Survey of Youth (NLSY79) from 1979 to 2018.…”

“…Two complementary studies published in JAMA Network Open shed light on the association between incarceration and mortality (Bovell-Ammon et al and Ruch et al). Bovell-Ammon et al explore the association between incarceration and mortality using cohort data from the National Longitudinal Survey of Youth (NLSY79) from 1979 to 2018. They found that, nationally, exposure to incarceration was associated with a significant increase in mortality among Black participants compared with non-Black participants (adjusted hazard ratio, 1.65; 95% CI, 1.18-2.31).…”

“…Both studies provide clear empirical support of what Jared Sexton, PhD, refers to as the “assault on Black public health.” The criminal justice system is not only a “manifestation of structural racism,” but it also produces health disparities through the life-depleting effects experienced by Black individuals, rendering the carceral state a contributor to racial violence. Indeed, the slow death that both Ruch et al and Bovell-Ammon et al identify should be thought of in relation to other direct and brutal forms of anti-Black state violence that is so often committed by agents of the criminal justice system . Moreover, it is precisely the dispersed and banal processes that render the mortality risks of incarceration so profoundly devastating, as they reflect the wearing down and utter exhaustion of life lived under regimes of racial violence …”