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. 2019 Oct 2;2(10):e1912516.
doi: 10.1001/jamanetworkopen.2019.12516.

Association of Restrictive Housing During Incarceration With Mortality After Release

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Free PMC article

Association of Restrictive Housing During Incarceration With Mortality After Release

Lauren Brinkley-Rubinstein et al. JAMA Netw Open. .
Free PMC article

Abstract

Importance: Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes.

Objective: To characterize the association of restrictive housing with reincarceration and mortality after release.

Design, setting, and participants: This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019.

Exposures: Restrictive housing during incarceration.

Main outcomes and measures: Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration.

Results: From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34).

Conclusions and relevance: This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Junker reported being employed by the North Carolina Division of Public Health. Dr Proescholdbell reported receiving grant funding from the US Centers for Disease Control and Prevention (grant 5NU17CE002728; prinicipal investigator: Mr Proescholdbell) during the conduct of the study. Dr Shanahan reported receiving grant funding from the Injury and Violence Prevention Branch of the North Carolina Division of Public Health during the conduct of the study. Dr Ranapurwala reported receiving grant funding from the North Carolina Division of Public Health during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Association of Restrictive Housing During Incarceration With Mortality After Release and Reincarceration in North Carolina, 2000-2016
All hazard ratios are adjusted for sex, race, and time-varying factors including age, prior incarcerations, time in incarceration, violence-related convictions, drug-related convictions, mental health screening recommendation, and mental health treatment receipt. The x-axis is on a logarithmic scale. Whiskers represent 95% CIs.

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