Examining COVID-19 mortality rates by race and ethnicity among incarcerated people in 11 U.S. state prisons (March-October 2021)

Abstract

Background: Populations who are incarcerated have experienced disproportionately high coronavirus disease 2019 (COVID-2019) mortality rates compared to the general population. However, mortality rates by race/ethnicity from federal, state, and local carceral settings are largely unavailable due to unregulated reporting; therefore, racial/ethnic inequities have yet to be examined. We aimed to estimate coronavirus disease 2019 (COVID-19) mortality rates among individuals incarcerated in U.S. state prisons by race and ethnicity (RE).

Methods: Public records requests to state Departments of Corrections were used to identify deaths from COVID-19 among incarcerated adults occurring from March 1-October 1, 2020. We requested race, ethnicity, and age specific data on deaths and custody populations; sufficient data to calculate age-adjusted rates were obtained for 11 state systems. Race and ethnic specific unadjusted deaths rates per 100,000 persons were calculated overall and by state, based on March 1, 2020 custody populations. Rate ratios (RR) and 95% confidence intervals (95%CI) compared aggregated age-adjusted death rates by race and ethnicity, with White individuals as the 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 death 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 death 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 death rates were higher among incarcerated Black, Hispanic and those of Other racial and ethnic 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.

Keywords: COVID-19; Health disparity; Incarceration.

Fig. 1

Reporting from State DOCs of Coronavirus Disease Case, Mortality, Race, and Ethnicity Data, March 1, 2020–October 1, 2020 Abbreviations: Asian American, Native Hawaiian, and Pacific Islander (AANHPI), Black (B), Hispanic (H), Native American and Alaskan Native (NAAN), White (W), Other (O), and Unknown (U) (Top) States sending at least partial data are displayed. Figure displays whether each state provided data sufficient to calculate case and mortality rates, case or mortality rates, neither case nor mortality rates, age-standardized mortality rates, or no data at all. States that sent 3/01/2021 custody population, 10/01/2021 case and mortality data by race/ethnicity (all RE groups for case data; White, Black, Hispanic, at minimum for mortality data) were considered having sent all data for case and mortality rate calculations. States that additionally sent mortality data by age are indicated as having sent all data necessary for calculating age-standardized mortality rates. *Data from WA were reported as ethnicity separate from race (Bottom) Displays the data sets and racial/ethnic categories reported by each state. States that requested fees are also indicated. States that sent SARS-CoV-2 case (“Case”) and/or mortality data (“Mortality”) by race/ethnicity are marked. Forward slash denotes states that reported Asian American, Native Hawaiian, and Pacific Islander in disaggregated racial categories. “E” denotes states reporting “Hispanic” as an ethnicity rather than a race category.