Age and COVID-19 mortality in the United States: a comparison of the prison and general population

• DOI: https://doi.org/10.1108/IJPH-08-2021-0069
• Published date: 23 June 2022
• Date: 23 June 2022
• Pages: 35-46
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Kathryn Nowotny,Hannah Metheny,Katherine LeMasters,Lauren Brinkley-Rubinstein

Age and COVID-19 mortality in the United

States: a comparison of the prison and

general population

Kathryn Nowotny, Hannah Metheny, Katherine LeMasters and Lauren Brinkley-Rubinstein

Abstract

Purpose –The USA has a rapidly aging prison population that, combined with their poorer health and living

conditions, is at extreme risk for COVID-19. The purpose of this paper is to compare COVID-19 mortality

trends in the US prison population and the general population to see how mortality risk changed over the

course of the pandemic. The authors first provide a national overview of trends in COVID-19 mortality; then,

the authors assess COVID-19 deaths among older populationsusing more detailed data from one US state.

Design/methodology/approach –The authors used multiplepublicly available data sets (e.g. Centers

for Disease Control and prevention, COVID Prison Project) and indirect and direct standardization to

estimate standardizedmortality rates covering theperiod from April 2020 to June 2021 for the US andfor

the Stateof Texas.

Findings –While 921 COVID-19-relateddeaths among people in US prisons were expected as of June

5, 2021, 2,664were observed, corresponding to a standardizedmortality ratio of 2.89 (95%CI 2.78, 3.00).

The observednumber of COVID-19-related deaths exceededthe expected number of COVID-19-related

deaths among peoplein prison for most of the pandemic, with a substantially wideninggap leading to a

plateau about fourweeks after the COVID-19 vaccine was introduced in the USA. In the state population,

the older population in prison is dyingat younger ages compared with the general population, with the

highestpercentage of deaths among people aged 50–64years.

Research limitations/implications –People who are incarceratedare dying of COVID-19 at a rate that

far outpacesthe general population and are dying at younger ages.

Originality/value –This descriptive analysisserves as a first step in understanding the dynamic trends

in COVID-19mortality and the association betweenage and COVID-19 death in US prisons.

Keywords Health in prison, Prisoners, Public health, Prison, Elderly prisoners, Infectious disease,

COVID-19 aging, Prison, Mortality

Paper type Research paper

In February 2021, the number of COVID-19-related deaths in the USA su rpassed 500,000

(Tompkins et al.,2021), with provisional life expectanc y estimates for 2020 showing a

1.5-year decline overall (Arias et al., 2021). However, the COVID-19 mortality burden is not

equally distributed. There is an exponential relationship between the COVID-19 infection fatality rate

(the proportion of people infected who die) and age (Levin et al., 2020). Early in the global

pandemic, a large epidemiological study in China found t hat the elderly and sick had the highest

risk of death with case fatality rates of 14.8% and 10.5% for people age d 80ye ars and older and

people with comorbid health conditions, respectively (Novel Cor onavirus Pneumonia Emergency

Response Epidemiology Team, 2020). The US Centers for Disease Control and Prevention (CDC)

documents that, compared with 18- to 29-year-olds, the rate of COVID-19 dea th is 600 times higher

for people aged 85 years and older [Centers for Disease Control and Prevention(CDC), 2021a].

The USA has a rapidly aging prison population that, combined with their poorer health and

living conditions, is at extreme risk for COVID-19. The percentage of people in prison who

Kathryn Nowotny is based

at the Department of

Sociology, University of

Miami, Coral Gables,

Florida, USA.

Hannah Metheny is based

at the Miller School of

Medicine, University of

Miami, Miami, Florida, USA.

Katherine LeMasters and

Lauren Brinkley-Rubinstein

are both based at the

Gillings School of Global

Public Health, University of

North Carolina at Chapel

Hill, Chapel Hill, North

Carolina, USA.

Received 1 August 2021

Revised 22 February 2022

10 May 2022

Accepted 26 May 2022

Jacob and Valeria Langeloth

Foundation US Department of

Health and Human Services >

National Institutes of Health

>National Institute on Drug

Abuse R25DA037190 Robert

Wood Johnson Foundation.

DOI 10.1108/IJPH-08-2021-0069 VOL. 19 NO. 1 2023, pp. 35-46, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 35