U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Data Brief Medical Causes of Death in State Prison, 2001-2004 January 2007, NCJ 216340 ------------------------------------------------------- This file is text only without graphics and many of the tables. A Zip archive of the tables in this report in Spreadsheet format (.csv) and the full report including tables and graphics in .pdf format are available from: http://www.ojp.usdoj.gov/bjs/abstract/mcdsp04.htm ------------------------------------------------------- by Christopher J. Mumola BJS Policy Analyst Between 2001 and 2004, State prison authorities nationwide reported a total of 12,129 State prisoner deaths to the Deaths in Custody Reporting Program (DCRP).***Total number of deaths excludes 258 State prison executions during 2001-2004. See Capital Punishment, 2005 .*** Nearly 9 in 10 of these deaths (89%) were attributed to medical conditions. Fewer than 1 in 10 were the result of suicide (6%) and homicide (2%), while alcohol/drug intoxication and accidental injury accounted for another 1% each. A definitive cause could not be determined for 1% of these deaths. This information was obtained from individual death records collected under the Death in Custody Reporting Act of 2000 (PL 106-297). These records provide the first national data on personal characteristics of inmates who died in custody and the circumstances of the deaths. Detailed data tables on the topics covered in this report are available as appendix tables on the BJS website at . Among State prisoner deaths -- * Half were the result of heart diseases and cancer * Two-thirds involved inmates age 45 or older * Two-thirds were the result of medical problems which were present at the time of admission * 40% occurred in 5 States (Texas, California, Florida, New York, and Pennsylvania) * Over 90% were evaluated by medical staff for the fatal illness; 93% received medications for the illness. Comparative mortality rates showed -- * Male State prisoners had a death rate 72% higher than female State prisoners * State prisoners had a 19% lower death rate than the adult U.S. resident population; among blacks, the mortality rate was 57% lower among prisoners. Heart diseases and cancer accounted for half of all State prison deaths Correctional authorities reported over 60 different fatal medical conditions, but prisoner deaths were heavily concentrated among a small number of diseases. Heart diseases (27%), including heart attacks, and cancer (23%) caused half of all State prisoner deaths from 2001 to 2004. When combined with liver diseases (10%) and AIDS-related causes (7%), two- thirds of all State prisoner deaths were caused by these four medical conditions. Death rates higher among men than women in 9 of the 10 leading causes of death While the leading causes of death were the same for both men and women in State prisons, men died at a much higher rate than women. The mortality rate of men for all causes of death (257 deaths per 100,000 inmates) was 72% higher than that of women (149 deaths per 100,000 inmates). For the top three causes of death (heart diseases, cancer, and liver diseases), the male death rate was twice the female rate. Septicemia (for example, streptococcal and staphylococcal infection) was the lone cause of death that was higher among female State prisoners (10 deaths per 100,000) than male State prisoners (5 per 100,000). Black and Hispanic inmate mortality rates identical; white inmates 67% higher Between 2001 and 2004 the mortality rates of black and Hispanic State prisoners were identical (206 deaths per 100,000 inmates), while the rate for white inmates (343 per 100,000) was 67% higher. For heart diseases and cancer, the mortality rate of whites was nearly twice that of blacks and Hispanics. Despite higher mortality rates for most leading causes of death, white inmates had a lower AIDS- related death rate (10 per 100,000) than black (26 per 100,000) and Hispanic (18 per 100,000) State prisoners. Two-thirds of State prison deaths involved inmates age 45 or older Mortality rates rose dramatically with age. The death rate of inmates age 55 and older (1,973 per 100,000) was over 3 times higher than that of inmates age 45-54 (566 per 100,000), and 11 times higher than those age 35-44 (177 per 100,000). Inmates age 45 or older comprised 14% of State prisoners from 2001 to 2004, but accounted for 67% of all inmate deaths over the same period. Unlike the leading fatal illnesses, suicide rates were stable across all adult age groups. While suicide was the leading cause of death for inmates under the age of 35, it fell far behind several illnesses as a cause of death for older inmates. Among inmates age 55 or older, there were 46 heart disease deaths and 42 cancer deaths for each suicide. Among deaths of elderly State prisoners, 85% were 45 or older when admitted Among older inmates, the mortality rate of those age 65 or older was particularly high. Though these elderly inmates made up 1% of prisoners, they accounted for 15% of prisoner deaths. The mortality rate of elderly prisoners was nearly 3 times higher than that of inmates age 55-64. The death rate for aortic aneurysm was 6 times higher among elderly inmates than those age 55-64; for respiratory diseases, the rate was 5 times higher. Deaths of elderly inmates typically did not involve offenders who had been incarcerated as young adults on lengthy (or "life") sentences. A majority (59%) of the elderly State prisoners who died during this period were 55 or older when admitted, and 85% were at least 45 years old at time of admission. Death from illness increased with time served in prison The death rate from illness rose sharply for prisoners serving lengthy terms. For inmates who had served at least 10 years in State prison, the mortality rate due to illness (503 deaths per 100,000 inmates) was triple that of inmates who had served less than 5 years in prison (162 per 100,000). Long-serving inmates showed similar increases in death rates for many of the leading fatal illnesses. AIDS-related causes had the smallest increase in mortality for long-serving inmates. ----------------------------------------------- Lung cancer accounted for 1 in 3 cancer deaths in State prison, more than the next 6 leading cancer sites combined A specific cancer site was named in 79% of the cancer deaths. Lung cancer alone accounted for 8% of all State prisoner deaths. More State prisoner deaths were caused by lung cancer (910) than the next 6 leading sites of cancer deaths (864) combined (i.e., liver, colon, pancreas, non-Hodgkins lymphoma, prostate, and leukemia). Men in State prison died from cancer at twice the rate of women (60 deaths per 100,000 inmates compared to 27 per 100,000). This gender difference in cancer death rates was particularly evident for the most common fatal cancer sites. Men died from lung, liver and colon cancer at a rate nearly triple that of women. Regardless of gender, lung cancer caused twice as many deaths as any other site. Deaths due to gender-specific cancer sites varied. Breast, ovarian, cervical and uterine cancer accounted for 24% of female cancer deaths. By comparison, prostate and testicular cancer accounted for 4% of male cancer deaths. Breast cancer was also the second most common site of female cancer deaths. ----------------------------------------------- Time served in prison played little role in the death rate due to communicable diseases Death rates from communicable diseases (other than AIDS) were much lower than those for the leading fatal illnesses, and did not show the same increases among long-serving inmates. There were no deaths in State prisons nationwide from syphilis, meningitis, or meningococcal infection. The death rate from tuberculosis was lower than 0.5 per 100,000 for all inmates, regardless of time served. The death rate for viral hepatitis (all types) was 1 per 100,000 for inmates who served less than 5 years and rose to 3 per 100,000 for inmates who served longer than 5 years. Two-thirds of illness deaths resulted from pre-existing conditions--including 94% of AIDS deaths In 68% of the illness deaths, State prison authorities reported that the fatal medical condition was present at the time of admission. AIDS (94%)***It is not known how many of the remaining 6% of AIDS-related deaths involved inmates whose HIV-positive status was undetected at time of admission and how many contracted HIV during their prison term.*** and liver diseases (88%) were most commonly present at the time of admission. Cancer was present at admission in 54% of all cancer fatalities. Among leading causes of death, influenza or pneumonia was least likely to be present at time of admission (39%). In 93% of deaths from illness, medical staff had provided medications for the fatal condition Among illness fatalities, 94% were evaluated by medical staff prior to death. Diagnostic tests, such as an x-ray, MRI, or blood test, were performed in 89% of these cases. For 93% of illness fatalities, medications had been administered for the fatal medical condition. Surgery had been performed on 1 in 5 inmates who died from illness. Among deaths from leading causes, prisoners who died from septicemia were most likely to have received surgical treatments (35%), followed by those who had cancer and digestive diseases (31% each). Fatalities from AIDS (11%) and heart diseases (15%) were least likely to have had surgery. Over 40% of prisoner deaths took place in 5 States; mortality rates varied widely across States Five States each recorded over 500 prisoner deaths from 2001 to 2004. Texas led all States with 1,582 deaths, followed by California (1,306), Florida (813), New York (712), and Pennsylvania (558). These five States accounted for 41% of all State prisoner deaths during the 4-year period. Illness mortality rates varied widely across States. Five States had more than 300 illness deaths per 100,000 inmates, while 10 States had fewer than 150 illness deaths per 100,000 inmates. Specific medical causes of death also varied widely across States: * Heart disease death rates varied from 10 per 100,000 in New Hampshire to 189 per 100,000 in West Virginia * Cancer death rates ranged from 0 in Vermont to 103 per 100,000 in Louisiana * Liver disease death rates varied from 0 in Rhode Island to 58 per 100,000 in Colorado. Mortality rate in State prisons nearly 20% lower than in U.S. resident population From 2001 to 2004, 99% of State prisoners were between ages 15 and 64. When compared to mortality rates for U.S. residents in this age group, the overall mortality rate of State prisoners was 19% lower during this period. White and Hispanic prisoners had death rates slightly above their counterparts in the resident population, while blacks were 57% less likely to die in State prisons. For all age groups under the age of 45, the death rate in State prisons was lower than in the U.S. resident population. For the 55 to 64 age group, prison death rates were 56% higher. ------------------------------------------------ Since 1991, AIDS-related death rate dropped 84%; death rate for all other illnesses rose 82% Prior to the enactment of the Death in Custody Reporting Act of 2000, the only national statistics on prisoner deaths from specific illnesses were annual counts of AIDS- related deaths begun in 1991. Between 1991 and 2004, sharply different trends emerged for the major causes of State prison deaths. While the death rate for AIDS dropped by over 80%, the death rate from all other illnesses rose by 82%. Over the same period, the suicide rate was nearly stable and homicide rates dropped by one-half.***See Suicide and Homicide in State Prisons and Local Jails .*** ------------------------------------------------ Methodology In 2001 BJS began collecting individual records of all State prisoner deaths pursuant to PL 106-297. Prior to the collection of these records, BJS collected aggregate death counts in the National Prisoners Statistics (NPS) program. Since 1978 NPS counts have used a single category of "illness/natural causes," with AIDS-related deaths collected as a separate count from all other illnesses starting in 1991. Records collected under the Deaths in Custody Reporting Program (DCRP) were submitted by correctional authorities in all 50 States for each year from 2001 to 2004. For each death marked as illness/natural cause, respondents were directed to specify a medical cause of death based on an autopsy review, if available. These text entries were later coded by clinical data specialists according to the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). BJS analysis of causes of death used categories of disease published by the National Center for Health Statistics (NCHS). See the NCHS website for mortality data for the U.S. resident population at . In compiling their DCRP records, States are instructed to include deaths of any inmates held in private prisons, medical facilities, substance abuse or mental health treatment centers, or any deaths at a work release site. Deaths of State prisoners held in local jails are excluded, but covered by a separate collection. Also excluded are executions and escaped inmates. ----------------------------------------------- The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jeffrey L. Sedgwick is director. This Data Brief was written by Christopher J. Mumola, under the supervision of Allen J. Beck. Margaret E. Noonan verified the report. Data collection and processing of 2001-2002 death records were carried out by Lara E. Allen; data collection and processing of 2003-2004 death records were carried out by Greta B. Clark and Pamela Butler, under the supervision of Charlene Sebold, Governments Division, Census Bureau, U.S. Department of Commerce. Greg Wolfe, of GW Services, converted all death causes from text to ICD-10 codes. Carolyn C. Williams and Tina Dorsey of BJS produced and edited the report and Jayne Robinson prepared the report for final printing, under the supervision of Doris J. James. January 2007, NCJ 216340 -------------------------------------------------- -------------------------------------------------- This report in portable document format and in ASCII and its related statistical data and tables are available at the BJS World Wide Web Internet site: . -------------------------------------------------- End of file 1/18/07 ih