key: cord-0830074-i6c440vf
authors: Marquez, Neal M.; Littman, Aaron M.; Rossi, Victoria E.; Everett, Michael C.; Tyagi, Erika; Johnson, Hope C.; Dolovich, Sharon L.
title: Life Expectancy and COVID-19 in Florida State Prisons
date: 2022-01-31
journal: Am J Prev Med
DOI: 10.1016/j.amepre.2021.12.011
sha: ba48f1f8e674fe5ba3545f2fdaa90fb1a55cbb9f
doc_id: 830074
cord_uid: i6c440vf

Introduction The heightened risk of coronavirus disease 2019 (COVID-19) infection and mortality in prisons is well documented, but COVID-19’s impact on all-cause mortality in incarcerated populations has not yet been studied. This study analyzed mortality records from the Florida State Department of Corrections (FLDOC) prison system population to evaluate the impact COVID-19 had on all-cause mortality and compare mortality rates and life expectancy in FLDOC with that of the overall state of Florida population. Methods Population age and sex data for FLDOC were ascertained from the FLDOC Offender Based Information System. FLDOC death data by age, sex, and cause of death were acquired from medical records and FLDOC offender reports. The state of Florida demographic and death data were collected from the Census Bureau, Florida Department of Health, and Centers for Disease Control and Prevention. All data were collected for the years 2019 and 2020. Age- and sex-standardized life table measures were calculated and COVID-19 contribution to changes in life expectancy were assessed using Arriaga's decomposition. Results The standardized mortality rate in the FLDOC population increased by 45% between 2019 and 2020, causing an overall 4.0-year decline in life expectancy. Over the same period, the state of Florida population's standardized mortality increased by 19%, resulting in an overall 2.7-year decline in life expectancy. Within the FLDOC population, life expectancy decline could be attributed exclusively to COVID-19 mortality. Conclusions The state of Florida prison population saw a substantial increase in mortality driven solely by COVID-19 mortality, leading to an overall 4-year decline in life expectancy. Given the findings and continued threat of COVID-19 outbreaks, FLDOC and other prison systems should strive to increase vaccination uptake, decrease prison populations, and commit to COVID-19 data transparency.

The heightened risk of coronavirus disease 2019 (COVID-19) infection and subsequent mortality for incarcerated people has been well documented, 1 ,2 yet the impact of COVID-19 on all-cause mortality in these populations has not been analyzed. To understand how the COVID-19 pandemic impacted all-cause mortality rates in prisons in the U.S., this study leveraged data from public records to analyze mortality trends in the Florida Department of Corrections (FLDOC) incarcerated population, the third largest state prison system in the country, 3 and compare them to trends in the state of Florida as a whole.

Demographic data for FLDOC, including age and sex, were ascertained using the FLDOC Offender Based Information System. 4 Monthly census counts were constructed for all months from January 2019 to December 2020. Equivalent data for the state of Florida were taken from the 2019 American Community Survey and held constant throughout the study period. 5 The FLDOC mortality data were aggregated for 2019 and 2020 from FLDOC fiscal year Inmate Mortality Reports, a publicly available database, with age and sex information, of all individuals who died while held in FLODC custody since 2015. 6 As causes of death were not provided in these reports, medical examiner records, obtained through record requests, for deaths within FLDOC in 2020 were used to identify COVID-19-related deaths. A death was considered COVID-19 related if the words -COVID‖ or -SARS‖ (severe acute respiratory syndrome) appeared in the first 5 causes of death. All-cause mortality and COVID-19 mortality data for the state of Florida were obtained from the Florida Department of Health 7 and Centers for Disease Control and Prevention, 8 respectively.

To assess differences in mortality, age-specific mortality rates and life expectancy were calculated for each calendar year, 2019 and 2020, for FLDOC and the state of Florida using standard life table methods. 9 For this analysis, life tables were initiated at age 20 years given that individuals aged <20 years represented <1% of FLDOC. As such, life expectancy in this analysis refers to period life expectancy at age 20 years. 9 

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