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Review 1: "Assessing the Mortality Impact of the COVID-19 Pandemic in Florida State Prisons"

Published onApr 14, 2022
Review 1: "Assessing the Mortality Impact of the COVID-19 Pandemic in Florida State Prisons"
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key-enterThis Pub is a Review of
Assessing the Mortality Impact of the COVID-19 Pandemic in Florida State Prisons

AbstractBackgroundThe increased risk of COVID-19 infection among incarcerated individuals due to environmental hazards is well known and recent studies have highlighted the higher rates of infection and mortality prisoners in the United States face due to COVID-19. However, the impact of COVID-19 on all-cause mortality rates in incarcerated populations has not been studied.MethodsUsing data reported by the Florida Department of Corrections on prison populations and mortality events we conducted a retrospective cohort study of all individuals incarcerated in Florida state prisons between 2015 and 2020. We calculated excess deaths by estimating age-specific expected deaths from mortality trends in 2015 through 2019 and taking the difference between observed and expected deaths during the pandemic period. We calculated life table measures using standard demographic techniques and assessed significant yearly changes using bootstrapping.FindingsThe Florida Department of Corrections reported 510 total deaths from March 1, 2020 to December 31, 2020 among the state prison population. This was 42% higher (rate ratio 1.42, 95% CI 1.15 to 1.89) than the expected number of deaths in light of mortality rates for previous years. Reported COVID-19 deaths in a month were positively correlated with estimated excess deaths (80.4%, p <.01). Using age-specific mortality estimates, we found that life expectancy at age 20 declined by 4 years (95% CI 2.06-6.57) between 2019 and 2020 for the Florida prison population.InterpretationThe Florida prison population saw a significant increase in all-cause mortality during the COVID-19 pandemic period, leading to a decrease in life expectancy of more than four years. Life years lost by the Florida prison population were likely far greater than those lost by the general United States population, as reported by other studies. This difference in years lost highlights the need for increased interventions to protect vulnerable incarcerated populations during pandemics.FundingVital Projects Fund, Arnold Ventures, US Centers for Disease Control, Eunice Kennedy Shriver National Institute of Child Health and Human Development

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 study is methodologically rigorous and transparent; attentive to potential sources of bias; and of immediate importance to activists, advocates, and policymakers. The study’s claims are well-supported by the methods and data. A detailed elaboration of the methods and methodological decisions increases confidence in the results and conclusions drawn from them, as well as the potential for replicability and reliability.

I have two comments on interpretational matters: First, in the fourth paragraph of the introduction, I would not characterize the 10% decrease in US prison populations as striking, but rather as modest, given that far more dramatic reductions were the obvious life-saving policy response to the pandemic.

Second, in the fifth paragraph of the discussion: Higher prevalence of preexisting conditions among incarcerated people is a reason why particular people may have died from uncontrolled exposure to COVID-19. Uncontrolled exposure to COVID-10—not preexisting conditions—is a reason for excess deaths due to COVID-19 in Florida state prisons.

Finally, the authors might provide a description of the UCLA Law COVID-19 Behind Bars Data Project design and methodology, in addition to institutional review board determinations.

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