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

  1. Neal Marcos Marquez
  2. Aaron Littman
  3. Victoria Rossi
  4. Michael Everett
  5. Erika Tyagi
  6. Hope Johnson
  7. Sharon Dolovich

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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, Eunice Kennedy Shriver National Institute of Child Health and Human Development

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  3. Version published to 10.1101/2021.04.14.21255512v2 on medRxiv
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    SciScore for 10.1101/2021.04.14.21255512: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our analysis has several limitations. First, COVID-19 deaths were attributed to the month in which the deaths were reported and not necessarily to the month in which the individuals died. As such, it is likely that, in some instances, we have attributed COVID-19-related deaths to later months than the months in which they actually occurred. Second, because causes of death were not included in death data provided by FLDOC, we were unable to attribute age and sex to reported COVID-19 deaths. As a result, we cannot specifically attribute changes in age-specific mortality rates to COVID-19. Nevertheless, the age-specific increases in overall mortality rates are in line with changes in mortality rates due to COVID-19 found in other settings.26,27 Lastly, mortality events among the prison population may not be observed or recorded if an individual who is terminally ill is granted parole or compassionate release. If the pandemic occasioned a substantial year-to-year change in the number of individuals being released through either of these channels, our analysis might fail to accurately capture changes in the mortality risks to the Florida prison population. To date, however, there is no evidence of such a change.28 Conclusion: To protect vulnerable incarcerated populations—including those held in FLDOC facilities—from COVID-19 and future viral pandemics, we must identify effective strategies for preventing infections in custody, for containing transmission, and providi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    • No protocol registration statement was detected.

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  5. Version published to 10.1101/2021.04.14.21255512v1 on medRxiv