Racial And Ethnic Inequalities In COVID-19 Mortality Within Carceral Settings: An Analysis Of Texas Prisons.

The COVID-19 pandemic has taken a heightened toll on people incarcerated in prisons in the United States, with those incarcerated experiencing a higher rate of infection and mortality than the US population more generally. What is less well known is the degree to which COVID-19 outcomes differ among incarcerated populations, especially by race and ethnicity, where significant differences have been found among the US population as a whole. This knowledge gap is, in part, due to a lack of reporting of COVID-19 outcomes by race and ethnicity by most state prison systems. To shed light on this topic, we analyzed mortality patterns of the population incarcerated in Texas state prison facilities during both the year before (beginning April 1, 2019) and the first year of (beginning April 1, 2020) the COVID-19 pandemic. We used a unique data set of roster information from the Texas Department of Criminal Justice and medical examiner records. COVID-19 mortality was 1.61 and 2.12 times higher for Black and Hispanic populations, respectively, when compared with the White population in Texas prisons. Strategies for COVID-19 mitigation in carceral settings, such as vaccination and decarceration, should include an equity component to minimize disparities.

Life Expectancy and COVID-19 in Florida State Prisons.

INTRODUCTION: The heightened risk of 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 prison system population to evaluate the impact COVID-19 had on all-cause mortality and compare mortality rates and life expectancy with that of the overall state of Florida population. METHODS: Population age and sex data for Florida State Department of Corrections were ascertained from the Florida State Department of Corrections Offender Based Information System. Death data by age, sex, and cause of death were acquired from medical records and Florida State Department of Corrections 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. Age- and sex-standardized life table measures were calculated, and COVID-19 contributions to changes in life expectancy were assessed using Arriaga's decomposition. RESULTS: The standardized mortality rate in the Florida State Department of Corrections 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. Within the Florida State Department of Corrections 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, Florida State Department of Corrections and other prison systems should strive to increase vaccination uptake, decrease prison populations, and commit to COVID-19 data transparency.

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

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.

Willingness to Receive a COVID-19 Vaccination Among Incarcerated or Detained Persons in Correctional and Detention Facilities - Four States, September-December 2020.

Incarcerated and detained persons are at increased risk for acquiring COVID-19. However, little is known about their willingness to receive a COVID-19 vaccination. During September-December 2020, residents in three prisons and 13 jails in four states were surveyed regarding their willingness to receive a COVID-19 vaccination and their reasons for COVID-19 vaccination hesitancy or refusal. Among 5,110 participants, 2,294 (44.9%) said they would receive a COVID-19 vaccination, 498 (9.8%) said they would hesitate to receive it, and 2,318 (45.4%) said they would refuse to receive it. Willingness to receive a COVID-19 vaccination was lowest among Black/African American (Black) (36.7%; 510 of 1,390) persons, participants aged 18-29 years (38.5%; 583 of 1,516), and those who lived in jails versus prisons (43.7%; 1,850 of 4,232). Common reasons reported for COVID-19 vaccine hesitancy were waiting for more information (54.8%) and efficacy or safety concerns (31.0%). The most common reason for COVID-19 vaccination refusal was distrust of health care, correctional, or government personnel or institutions (20.1%). Public health interventions to improve vaccine confidence and trust are needed to increase vaccination acceptance by incarcerated or detained persons.

COVID-19 Cases Among Employees of U.S. Federal and State Prisons.

INTRODUCTION: Previous research has found COVID-19 cases to be disproportionately prevalent among U.S. prisoners. Similar to prisoners, prison staff experience ventilation and social distancing hazards and may have limited access to testing, paid sick leave, personal protective equipment, and other workplace protections. Yet, systematic case surveillance among prison staff remains unexplored. The objective of this study is to document the trends in COVID-19 cases among U.S. correctional staff relative to those among prisoners and the U.S. METHODS: Reports of COVID-19 cases among prisoners and staff were collected from state Departments of Corrections and the Federal Bureau of Prisons from March 31, 2020 to November 4, 2020. In November 2020, this series of aggregated case records was linked to population estimates to calculate COVID-19 period prevalence among prison staff and residents in comparison with the U.S. population trends. RESULTS: Within the prison environment, COVID-19 case burden was initially higher among staff than among prisoners in 89% of jurisdictions. Case prevalence escalated more quickly among prisoners but has remained persistently high among staff. By November 4, 2020, COVID-19 was 3.2 times more prevalent among prison staff than among the U.S. CONCLUSIONS: Prison staff experienced substantially higher COVID-19 case prevalence than the U.S. population overall. Across prison staff and resident populations, cases were rapidly rising in November 2020, indicating poor outbreak containment within the prison environment. An Emergency Temporary Standard, issued by federal and state Occupational Safety and Health Administrations, and priority vaccination are urgently needed to reduce COVID-19 occupational risk. Reduced occupational transmission of COVID-19 will benefit workers, incarcerated people, and community members alike.