Even neighbors are associated with death risk

Living in areas with high incarceration rates increases the risk of death for everyone, not just those incarcerated, in a new study that tracks more than three million Americans over 11 years.

The study shows that incarceration has a chain reaction of premature death, far beyond the reach of individual prisoners to the entire community, with the county jail population increasing by about five deaths per 100,000 residents per 10%.

The double burden of incarceration

The study, published in JAMA Network Open, examines individual incarceration status and county-level prison rates using data from the U.S. community survey related to official death records. The findings paint a stark picture of how mass incarceration affects American health.

People who were imprisoned at the time of investigation were at risk of dying for any reason compared to those who were not closed. What’s even more amazing is that they are three times more likely to die from drug overdose.

But that’s what makes the study particularly eye-opening—people who have never been incarcerated but live in counties with high jail populations also face elevated mortality rates.

Regional mode appears

The study identified disturbing geographical patterns throughout the United States. Many counties in the southeast show both the highest prison incarceration rates and all-cause mortality rates, highlighting how criminal justice policies and health status intersect regionally.

Utsha Khatri, lead investigator at the Icahn School of Medicine at Mount Sinai, noted the community-wide impact: “Incarceration increases mortality at the individual and community level, highlighting its significance as a key public health issue.”

Who is trapped in the system?

Demography tells a familiar story of inequality. The vast majority of people who are imprisoned:

• Male (general population is 90.4% ves 48.3%)
• Young (54.3% of 35 years or younger, compared with 31.7% overall)
• Lower education (39.6% lack high school diplomas, compared with 15.1% usually)
• From high poverty and larger black communities

These patterns reflect deeper structural inequality that drives incarceration and worsens health outcomes.

Excessive crisis connection

Perhaps nothing is harder to detect than excessive statistics. While county incarceration rates do not directly increase the risk of overdose alone, people with a history of incarceration face a huge chance of fatal overdose.

This connection becomes even more pressing considering that nearly 50% of incarcerated populations struggle with substance use disorders. However, most U.S. prisons fail to provide evidence-based addiction treatments, such as methadone or buprenorphine.

Research from New York City prisons found that overdose and all-cause mortality rates of these drugs were reduced by 80%. Norwegian prisons that integrate health care with the state system show similar life-saving results.

More than the previous two weeks

Although previous studies focused on the first week of danger after release (at the peak of excessive risk), the 11-year follow-up of this study revealed long-term patterns. The researchers found that as they age, the survival differences between incarcerated and non-incarcerated groups significantly widened.

For those aged 30-34, the survival rate of non-incarnated individuals is 99%, while the survival rate of incarcerated individuals is 96.9%. By the age of 70-74, the gap has grown to 20 percentage points.

Policy changes are about to change

These findings are because policy makers believe that incarceration is both a health barrier and an opportunity for intervention. In April 2023, the Centers for Medicare and Medicaid Services began allowing states to provide Medicaid services to certain incarcerated persons 90 days before release.

Now 11 states have obtained approval for these programs, and this is the first time Medicaid has expanded eligibility for incarcerated persons. Early evidence from Rhode Island suggests that this Medicaid expansion significantly reduces post-release mortality.

Need a community-wide solution

Research shows that addressing the health effects of incarceration requires more than just prison reform. Since county incarceration rates affect everyone’s risk of death, community-level interventions become critical.

“Enhanced health care in communities with high incarceration rates, such as expanding opportunities for community-based primary care, a strategy to reduce mortality at the population level, may help address structural factors that contribute to poor health in these areas and mitigate the associated elevated risks,” Dr. Khatri explained.

The study highlights how mass incarceration works, which not only affects the public health crisis of 2.3 million Americans, but also affects millions of shadows.