County-level jail incarceration and cancer mortality in the US.

Abstract

6535 Background: Incarceration has been linked to poor community health outcomes, such as worse preterm births and mortality in the US, although little research has examined cancer outcomes. This study examined associations of county-level jail incarceration and cancer mortality. Methods: Annual county-level local jail incarceration rates (1990-2018) were obtained from the Vera Institute of Justice. We calculated annual county-level mortality rates (2000 -2019) with invasive cancer as the underlying cause of death (ICD-10 codes: C00-C97) using National Vital Statistics System. Associations of county-level jail incarceration and cancer mortality overall, and by sex, race, and common cancer sites were examined with generalized estimating equations with Poisson distribution and standard errors clustered at county level. To assess the short-, medium-, and long-term associations, we used lagged county-level incarceration rates by 1, 5, and 10 years prior to mortality rates in separate analyses. Results: Over the 20-year study period, each 1 per 1000 increase in county jail incarceration rate was associated with a 1.2% increase in cancer mortality rate in the short-term (model with 1-year lags, rate ratio (RR): 1.012, 95% CI: 1.009–1.015) and 1.1% increase in medium-term (5-year lags (RR: 1.011, 95% CI: 1.008–1.014) and 0.8% increase long-term (10-year lags (RR: 1.008, 95% CI: 1.004–1.012). After adjusting for county-level sociodemographic characteristics, the RRs were attenuated but remained statistically significant. Jail incarceration was associated with higher cancer mortality for all common cancers included in the study (Table) and for White people, but not for Black people. The magnitude of associations was similar for medium- and long-term effects (5- and 10-year lags, respectively). Conclusions: Higher county-level jail incarceration rates were associated with higher county-level cancer mortality rates, underscoring the collateral health consequences of mass incarceration. Efforts to identify interventions to decrease the cancer mortality burden in these communities are warranted. [Table: see text]