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

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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
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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 <http://www.ojp.usdoj.gov/bjs/
abstract/cp05.htm>.*** 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
<www.ojp.usdoj.gov/bjs/abstract/mcdsp04.htm>.

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.

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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.
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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.

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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 <http://www.ojp.
usdoj.gov/bjs/abstract/shsplj.htm>.*** 
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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
<http://www.cdc.gov/nchs/deaths.htm>.

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.

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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
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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:
<http://www.ojp.usdoj.gov/bjs/abstract/mcdsp04.htm>.
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End of file
1/18/07 ih