Mortality risk halves during the period of incarceration, with large declines in murders, overdoses, and better diet

Norris, Samuel and Pecenco, Matthew and Weaver, Jeffrey, The Effect of Incarceration on Mortality (July 2, 2020). SSRN: http://dx.doi.org/10.2139/ssrn.3644719

Abstract: This paper analyzes the effect of incarceration on mortality using administrative data from Ohio between 1992 and 2017. Using event study and difference-in-differences approaches, we compare mortality risk across incarcerated and non-incarcerated individuals before and after pre-scheduled releases from prison. Mortality risk halves during the period of incarceration, with large declines in murders, overdoses, and medical causes of death. However, there is no detectable effect on post-release mortality risk, meaning that incarceration increases overall longevity. We estimate that incarceration averts nearly two thousand deaths annually in the US, comparable to the 2014 Medicaid expansion.

Keywords: Incarceration, health, mortality, crime

2.2 Direct effects of incarceration on mortality

The first column of Panel A of Table 1 estimates the DiD specification from Equation 3 on

mortality risk, measured in deaths per hundred thousand individuals annually. The coefficient

on “Incarcerated in quarter,” corresponding to β in the previous section, measures the direct

effect of incarceration. We estimate that incarceration reduces mortality risk by 365 deaths per

hundred thousand (p < 0.001) relative to the post-release mean of 622.4. This is a nearly sixty

percent reduction in mortality risk and is approximately equal to the difference in mortality

between smokers and non-smokers aged 45-54 (Banks et al., 2015).

We use detailed cause of death information to understand the factors underlying this effect.

The most common non-medical cause of death in our sample is overdose (29% of post-release

deaths), which approximately halves during the period of incarceration, declining by 99.8

deaths per hundred thousand (column 2).10 This reduction may reflect addiction treatment

or more difficulty obtaining narcotics while incarcerated.11

Contrary to popular portrayals of correctional facilities, murder and suicide are greatly

reduced during the period of incarceration, though not completely eliminated (columns 3 and

6).12 Murder is particularly important since it is the third most common risk-factor in this

sample (19.4% of deaths post-release), highlighting the dangerous environment faced by the

criminally-involved outside of correctional facilities. The presence of correctional officers and

lack of access to firearms while incarcerated both likely play a significant role; firearms are

involved in 85% of homicides and 38% of suicides in our sample.

Inmates are constitutionally guaranteed medical care, and there may be changes to diet

or lifestyle that affect mortality risk. We find a large reduction in deaths (55 per hundred

thousand) due to medical causes during the period of incarceration (column (4) of Table 1).

Panel B of Table 1 finds the gains mostly come from reductions in heart disease, infection, and

non-classified causes. Even if the quality of prison medical care is suboptimal, many inmates

receive better care than they would otherwise. For example, 79.9% of inmates with persistent

medical problems reported being examined by a medical professional upon intake and twice

as many inmates with serious mental health conditions receive psychiatric medication during

incarceration as compared to prior to arrest (Wilper et al., 2009).

In summary, we find that incarceration dramatically reduces mortality.