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Review 2: "Disparities in COVID-19 Related Mortality in U.S. Prisons and the General Population"

This study draws much-needed attention to the higher COVID-19 mortality burden among US prison populations, however, reviewers raised several methodological concerns involved in the authors' calculations of the scale of the disparities.

Published onNov 06, 2020
Review 2: "Disparities in COVID-19 Related Mortality in U.S. Prisons and the General Population"
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key-enterThis Pub is a Review of
Disparities in COVID-19 Related Mortality in U.S. Prisons and the General Population

We provide an analysis of COVID-19 mortality data to assess the potential magnitude of COVID-19 among prison residents. Data were pooled from Covid Prison Project and multiple publicly available national and state level sources. Data analyses consisted of standard epidemiologic and demographic estimates. A single case study was included to generate a more in-depth and multi-faceted understanding of COVID-19 mortality in prisons. The increase in crude COVID-19 mortality rates for the prison population has outpaced the rates for the general population. People in prison experienced a significantly higher mortality burden compared to the general population (standardized mortality ratio (SMR) = 2.75; 95% confidence interval = 2.54, 2.96). For a handful of states (n = 5), these disparities were more extreme, with SMRs ranging from 5.55 to 10.56. Four states reported COVID-19 related death counts that are more than 50% of expected deaths from all-causes in a calendar year. The case study suggested there was also variation in mortality among units within prison systems, with geriatric facilities potentially at highest risk. Understanding the dynamic trends in COVID-19 mortality in prisons as they move in and out of hotspot status is critical.

RR:C19 Evidence Scale rating by reviewer:

  • Strong. The main study claims are very well-justified by the data and analytic methods used. There is little room for doubt that the study produced has very similar results and conclusions as compared with the hypothetical ideal study. The study’s main claims should be considered conclusive and actionable without reservation.



This is a review of the manuscript “disparities in COVID-19 related mortality in US prisons in the general population.”

First, I should note that I have a professional, collaborative relationship with author Lauren Brinkley-Rubinstein. We have collaborated for several years on mauscripts and research grants. I am familiar with the Covid Prison Project, which is integral to this paper, however I have not been aware of this paper or discussed it with her or any of the other authors. Furthermore, I believe I can give it an unbiased review, in spite of this.

This project uses pooled, publicly available data on COVID-19 mortality in correctional settings in the US compared with community mortality related to COVID-19. They found a significantly higher mortality burden overall for people in prison and several states where these disparities were extreme. The authors appropriately conclude that these findings underscore the need for more drastic release efforts.

Although the study is limited by available data, this is crucial data with valid conclusions and unlikely to be changed by more accurate information.

The findings are strong or strong to reliable, and certainly actionable without reservation, and with some urgency, I might add.

The main findings are consistent with sparse published literature to date and highlights and extends our knowledge substantially.

The major limitation of the study, which I believe is directly a result of a limitation of the available data, is the lack of information on racial and ethnic status of individuals in the criminal justice system with COVID-19. That should be noted in the discussion and, if there is any available data, perhaps that should be included in the results.

This data is rapidly evolving and the data should be updated at the time of final publication.

I would strongly recommend this be accepted with the above noted minor revisions.

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