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

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 populations using more detailed data from one US state.

The authors used multiple publicly available data sets (e.g. Centers for Disease Control and prevention, COVID Prison Project) and indirect and direct standardization to estimate standardized mortality rates covering the period from April 2020 to June 2021 for the US and for the State of Texas.

While 921 COVID-19-related deaths among people in US prisons were expected as of June 5, 2021, 2,664 were observed, corresponding to a standardized mortality ratio of 2.89 (95%CI 2.78, 3.00). The observed number of COVID-19-related deaths exceeded the expected number of COVID-19-related deaths among people in prison for most of the pandemic, with a substantially widening gap leading to a plateau about four weeks after the COVID-19 vaccine was introduced in the USA. In the state population, the older population in prison is dying at younger ages compared with the general population, with the highest percentage of deaths among people aged 50–64 years.

People who are incarcerated are dying of COVID-19 at a rate that far outpaces the general population and are dying at younger ages.

This descriptive analysis serves as a first step in understanding the dynamic trends in COVID-19 mortality and the association between age and COVID-19 death in US prisons.