U.S. Department of Justice

Office of Justice Programs

Bureau of Justice Statistics

Data Brief

January 2007, NCJ 216340

Medical Causes of Death in State 

Prisons, 2001-2004

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).* 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.

*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>.

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). 

10 leading causes of State prisoner deaths, 2001-04

 Digestive diseases

Influenza/pneumonia

 Septicemia

 Cerebrovascular diseases

 Respiratory diseases

 Suicide

 AIDS

 Liver diseases

 Cancer

 Heart diseases

0 500 1,000 1,500 2,000 2,500 3,000 3,500
2 Medical Causes of Death in State Prisons, 2001-2004

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 AIDSrelated 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.

Average annual mortality rate, per 

100,000 State prisoners, by age

Cause of death 25-34 35-44 45-54 55 or older

Leading illnesses

Heart diseases 11 41 144 689

Cancer 5 28 135 635

Liver diseases 2 19 96 126

Respiratory diseases 2 5 18 107

Suicide 16 14 15 15

Note: Respiratory diseases exclude influenza and pneumonia.

Average annual mortality rate per 

100,000 State prisoners, by time served

Cause of death

Less than 

60 mos. 60-119 mos.

120 mos. 

or longer

Heart diseases 47 84 160

Cancer 38 70 151

Liver diseases 20 31 48

AIDS-related 16 21 24

Respiratory diseases 7 13 38

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.

Cancer deaths in State prisons, 2001-04

Prostate

Non-Hodgkin's lymphoma

Pancreas

Colon

Liver 

Other cancers

Site unspecified

Lung

0 200 400 600 800 1,000
Medical Causes of Death in State Prisons, 2001-2004 3

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%)* 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.

*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.

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.

Illness mortality rate per 100,000 State inmates, 2001-2004

Five highest Five lowest

Louisiana 388 Vermont 108

Tennessee 344 Alaska 111

Pennsylvania 328 Iowa 111

West Virginia 326 North Dakota 116

Kentucky 323 Utah 116

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>.

Mortality rate per 100,000 State prisoners, 1991-2004

1991 1995 1999 2003

0

50

100

150

200

250

Illness (excludes AIDS)

Other causes

AIDS
U.S. Department of Justice

Office of Justice Programs

Bureau of Justice Statistics

Washington, DC 20531

Official Business

Penalty for Private Use $300

PRESORTED STANDARD

POSTAGE & FEES PAID

DOJ/BJS

Permit No. G-91

*NCJ~216340*

4 Medical Causes of Death in State Prisons, 2001-2004

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>.

Office of Justice Programs

Partnerships for Safer Communities

http://www.ojp.usdoj.gov

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

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.
Medical Causes of Death in State Prisons, 2001-2004 5

Appendix table 1. Causes of death in State prisons, with average annual 

mortality rate per 100,000 inmates, 2001-2004

Number of State prisoner deaths Percent,

Average annual 

mortality rate, per 

100,000 inmates,

Cause of death 2001 2002 2003 2004 2001-04 2001-04

All causes 2,878 2,946 3,167 3,138 100.0% 250

Heart diseases 788 828 836 862 27.3% 68

Cancer 655 660 786 719 23.3 58

Liver diseases 320 301 315 294 10.1 25

Chronic liver disease/cirrhosis 89 88 78 84 2.8 7

Other liver diseases 231 213 237 210 7.3 18

AIDS 270 245 210 145 7.2 18

Suicide 169 168 200 200 6.1 15

Respiratory diseasesa 97 125 130 143 4.1 10

Chronic lower respiratory diseases 31 35 39 57 1.3 3

Lung diseases due to external agents 2 2 2 2 0.1 0

Other/unspecified respiratory diseases 64 88 89 84 2.7 7

Cerebrovascular diseases 93 90 122 89 3.2 8

Septicemia 50 64 67 81 2.2 5

Influenza/pneumonia 47 47 74 57 1.9 5

Digestive diseasesb 40 61 56 49 1.7 4

Disorders of the gall bladder, biliary 

tract & pancreas 7 5 8 5 0.2 1

Diseases of the esophagus, stomach 

and duodenum 4 7 7 4 0.2 0

Diseases of the peritoneum 5 3 4 5 0.1 0

Noninfective enteritis and colitis 1 1 2 1 0.0 0

Other diseases of the intestines 4 8 7 6 0.2 1

Other/unspecified digestive diseases 19 37 28 28 0.9 2

Kidney diseases 39 47 57 57 1.6 4

Nephritis, nephrosis, nephrotic 

syndrome 39 44 55 55 1.6 4

Renal tubulo-interstitial diseases 0 1 1 1 0.0 0

Other disorders of the kidney and

ureter 0 2 1 1 0.0 0

Homicide 39 48 50 51 1.6 4

Alcohol/drug intoxication 36 37 23 23 1.0 2

Accidental injury 23 31 26 37 1.0 2

Viral hepatitis (all types) 9 16 17 40 0.7 2

Aortic aneurysm 18 15 17 28 0.6 2

Diabetes mellitus 21 11 11 16 0.5 1

Other disorders of the nervous system 12 4 8 10 0.3 1

Anemias 5 8 8 5 0.2 1

Benign neoplasms, in situ neoplasms 6 9 4 7 0.2 1

Unspecified illness deaths — 74 59 71 110 2.6 6

Illness — specific medical cause 

unknown 64 48 56 101 2.2 6

Illness — multiple medical causes, 

unresolvedc 10 11 15 9 0.4 1

All other illnesses 29 34 54 78 1.6 4

Deaths without a known cause — 38 38 25 37 1.1 3

Unknown cause of death 33 36 16 30 0.9 2

Multiple causes, unresolvedd 5 2 9 7 0.2 0

Note: Detail may not add to total due to rounding. The 20 leading causes of death listed in the table account 

for 94.7% of all State prison deaths during 2001-2004. Executions are not included; for data on executions, see 

Capital Punishment, 2005, <http://www.ojp.usdoj.gov/bjs/abstract/cp05.htm>. aExcludes influenza and pneumonia.

bExcludes liver diseases.

c

In all such cases, none of the causes of death matched the 63 medical causes of death cited in any record 

for which a single illness was identified as the cause of death.

dSuch cases were checked "other causes of death," with a text description of events, but the information

was insufficient to classify the death to a single cause.
6 Medical Causes of Death in State Prisons, 2001-2004

Appendix table 2. Profile of cancer deaths in State prisons, 2001-2004

Number of State prison inmate deaths, 2001-04

Gender Race/Hispanic origin Age

Site of cancer 

All 

inmates Male Female White Black Hispanic

Under 

18 18-24 25-34 35-44 45-54

55 or 

older

All causes of death 12,129 11,645 482 5,898 4,714 1,285 7 292 1,041 2,616 3,758 4,402

Cancer, all sites 2,820 2,731 88 1,461 843 218 0 15 75 415 894 1,418

Lunga 910 885 25 505 351 44 0 2 4 114 279 511

Liverb 276 273 3 111 96 65 0 1 1 22 128 124

Colonc 171 166 5 85 60 21 0 1 2 30 59 79

Pancreas 124 123 1 55 52 13 0 0 2 18 37 67

Non-Hodgkin's lymphoma 114 112 2 65 34 14 0 2 7 24 43 38

Prostate 92 92 0 45 38 9 0 0 0 0 9 83

Leukemia 87 84 3 42 36 8 0 2 11 26 21 27

Lip, oral cavity, and pharynx 68 67 1 39 24 3 0 0 0 7 26 35

Stomach 61 59 2 21 35 5 0 1 2 12 19 26

Kidney and renal pelvis 61 60 1 25 33 3 0 0 2 11 25 23

Esophagus 51 50 1 35 12 3 0 0 0 4 12 35

Other lymphoid, hematopoietic 

and related tissued 44 43 1 17 23 3 0 1 1 7 14 21

Bladder 32 31 1 24 7 0 0 0 0 1 7 24

Skin 29 28 1 24 3 1 0 0 2 11 8 8

Larynx 29 28 1 16 12 1 0 0 0 0 8 21

Breast 17 4 13 4 12 0 0 0 2 6 6 3

Testicles 14 14 0 5 5 4 0 1 5 7 1 0

Ovary 5 0 4 4 0 1 0 0 0 2 2 1

Cervix uteri 3 0 3 1 2 0 0 0 1 1 1 0

Meninges, brain, and central 

nervous system 3 0 3 1 2 0 0 0 1 1 1 0

Corpus uteri and uterus, part 

unspecificed 1 0 1 0 1 0 0 0 0 0 0 1

Hodgkin's disease 0 0 0 0 0 0 0 0 0 0 0 0

All other types of cancer 72 71 1 31 27 10 0 2 15 20 14 21

Cancer, type unspecified 585 568 17 323 211 37 0 3 22 99 180 279

Note: Detail does not sum to total because multiple sites of cancer were identified for some cases. aIncludes the trachea and bronchus.

bIncludes the bile ducts.

cIncludes the rectum and anus.

dExcludes Hodgkin's disease, non-Hodgkin's lymphoma, and leukemia.
Medical Causes of Death in State Prisons, 2001-2004 7

Appendix table 3. Average annual mortality rate, per 100,000 State prison inmates, from leading causes of death, 

by selected characteristics, 2001-2004

Average annual mortality rate, per 100,000 State prison inmates, 2001-04

All

inmates

Gender Race/Hispanic origin Age

Cause of death Male Female White Black Hispanic Under 18 18-24 25-34 35-44 45-54

55 or 

older

All causes 250 257 149 343 206 206 107 34 64 177 566 1,973

Heart diseases 68 71 35 102 56 38 0 4 11 41 144 689

Cancer 58 60 27 85 47 39 0 2 5 28 135 635

Liver diseases 25 26 14 37 14 40 0 0 2 19 96 126

AIDS 18 18 12 10 26 18 0 1 8 28 40 25

Suicide 15 15 12 24 8 17 46 14 16 14 15 15

Respiratory diseasesa 10 10 7 15 9 5 0 2 2 5 18 107

Cerebrovascular diseases 8 8 7 10 8 6 0 1 2 4 21 70

Septicemia 5 5 10 7 5 4 0 0 1 3 15 46

Influenza/pneumonia 5 5 4 7 3 4 0 0 1 3 9 43

Digestive diseasesb 4 4 2 5 4 6 0 0 1 3 11 32

Number of deaths, 2001-04 12,129 11,645 482 5,898 4,714 1,285 7 292 1,041 2,616 3,758 4,402

Note: The 10 leading causes of death accounted for 90% of all deaths in State prisons during 2001-2004 with a reported cause. 

Records on 2 deaths did not indicate the gender of the deceased and 13 records were missing the age of the deceased. 

aExcludes influenza and pneumonia.

bExcludes liver diseases.

Appendix table 4. Average annual mortality rate of State 

prisoners age 55 or older, by cause of death, 2001-2004

Average annual mortality rate, per 

100,000 State inmates, 2001-04

Cause of death Age 55-64 Age 65 or older

All causes 1,481 3,758

Illness/natural cause* 1,434 3,705

Heart diseases 457 1,528

Cancer 522 1,052

Respiratory diseases 57 288

Cerebrovascular diseases 46 153

Influenza/pneumonia 25 111

Liver diseases 132 103

Septicemia 33 88

Digestive diseases 22 70

Aortic aneurysm 10 62

Kidney diseases 24 58

Accidental injury 5 10

Suicide 17 10

Homicide 8 4

Other 1 4

Intoxication 4 2

Unknown 12 23

Average annual custody population 43,790 12,133

Number of deaths, 2001-04 2,576 1,826

*Includes the 10 leading causes of illness deaths among inmates age 65 or 

older.

Appendix table 5. Time served since 

admission for deaths in State prison, 

age 65 or older, 2001-2004

Time served 

since admission

Percent of State 

prisoner deaths, 

age 65 or older, 

2001-04

Less than 1 month 0.7%

1-5 months 4.0

6-11 months 4.4

12-23 months 8.9

24-59 months 17.9

60-119 months 23.1

120-239 months 26.0

240 months or more 15.0
8 Medical Causes of Death in State Prisons, 2001-2004

Appendix table 6. Average annual mortality rate for leading causes of illness 

deaths in State prison, by time served, 2001-2004

Average annual mortality rate, per 100,000 inmates, 2001-04

Time served after admission (in months)

Cause of death

All 

inmates

Less 

than 12 12-23 24-59 60-119

120 or 

more

All illnesses 223 140 164 184 264 503

Heart diseases 69 44 47 52 84 160

Cancer 58 30 41 46 70 151

Liver diseases 25 14 21 25 31 48

AIDS 18 16 16 16 21 24

Respiratory diseasesa 10 7 6 8 13 38

Cerebrovascular diseases 8 5 6 6 11 16

Septicemia 5 4 3 5 5 12

Influenza/pneumonia 5 3 4 4 5 10

Digestive diseasesb 4 3 3 44 9

Kidney diseases 4 2 3 3 5 11

Number of illness deaths, 

2001-04c 10,830 1,908 1,362 2,317 2,106 3,038

Note: Estimates of the number of State prisoners in each category of time served are drawn 

from the 2004 Survey of Inmates in State Correctional Facilities. aExcludes influenza and pneumonia.

bExcludes liver diseases. cTotal includes 29 illness deaths in 2001, 23 illness deaths in 2002, 2 illness deaths in 2003, 

and 45 illness deaths in 2004 missing information on time served.

Appendix table 7. Average annual 

mortality rate for selected communicable 

diseases in State prisons, by time served, 

2001-2004

Selected

communicable

diseases

Average annual mortality rate, 

per 100,000 inmates, 2001-04, 

by time served (in months)

0-11 12-59 60 or more 

Viral hepatitis 1 13

Tuberculosis <0.5 <0.5 <0.5

Meningitis 0 0 0

Meningococcal 

infection 0 0 0

Syphilis 0 0 0

Note: Estimates of the number of State prisoners 

in each category of time served were drawn from 

the 2004 Survey of Inmates in State Correctional 

Facilities.

Appendix table 8. Leading causes of illness deaths in State prisons, by pre-existing status at time of admission 

and medical treatment provided, 2001-2004

Medical treatment provided for the fatal medical condition

Cause of death

Pre-existing 

condition at time 

of admission

Evaluated by 

physician/

medical staff

Diagnostic test 

(e.g., x-rays, 

MRI, blood test,) Medications

Treatments 

other than 

medication Surgery

Housed in a 

special 

medical unit

All illnesses 68.3% 94.1% 89.3% 93.3% 70.7% 20.1% 68.2%

Heart diseases 68.4% 90.1% 82.7% 86.8% 57.9% 14.6% 48.3

Cancer 54.4 96.5 94.5 97.8 82.6 30.7 84.7

Liver diseases 88.5 96.7 92.4 97.1 70.7 15.5 74.3

AIDS 93.5 96.2 93.3 96.4 72.8 11.5 72.1

Respiratory diseasesa 71.9 95.9 63.9 96.7 73.2 12.2 70.8

Cerebrovascular diseases 52.4 89.2 80.9 85.7 64.0 22.8 61.8

Septicemia 68.7 95.5 90.3 95.6 81.4 35.4 82.4

Influenza/pneumonia 38.6 96.2 90.5 96.0 76.4 19.0 70.6

Digestive diseasesb 67.7 95.6 87.5 93.3 75.3 31.5 71.9

Kidney diseases 77.4 97.1 95.9 97.5 83.8 23.5 77.4

Note: Percentages are based on cases in which provision of specific medical treatments was known. aExcludes influenza and pneumonia.

bExcludes liver diseases.
Medical Causes of Death in State Prisons, 2001-2004 9

Appendix table 9. Average annual mortality rate of State prison inmates, 

per 100,000 inmates, from leading causes of illness deaths, by State, 2001-2004

Total 

number of

deaths, 

2001-04

Average annual mortality rate, per 100,000 State prison inmates, 2001-04

Region and 

jurisdiction

All 

illnesses

Heart 

diseases Cancer

Liver 

diseases AIDS

Respiratory 

diseasesa

U.S. totalb 12,120 223 68 58 25 18 10

Northeast 1,832 237 74 53 29 26 10

Connecticutc 130 141 47 15 32 9

Maine 19 233 81 65 41 15 0

Massachusetts 104 226 86 64 20 10 0

New Hampshire 23 163 10 92 30 10 10

New Jersey 248 201 67 37 12 39 10

New York 712 240 63 59 30 45 10

Pennsylvania 558 328 115 70 41 ... 15

Rhode Islandc 26 121 49 36 0 14 0

Vermontc 12 108 36 0 36 36 0

Midwest 2,195 203 79 53 19 8 10

Illinois 337 166 63 42 14 19 3

Indiana 209 219 70 52 21 7 12

Iowa 48 111 30 51 9 0 9

Kansas 105 258 84 65 22 3 6

Michigan 492 231 94 68 24 8 10

Minnesota 47 143 44 41 29 0 4

Missouri 265 207 87 47 19 7 9

Nebraska 29 156 44 37 38 6 6

North Dakota 6 116 71 20 25 0 0

Ohio 446 232 99 60 15 7 18

South Dakota 31 184 75 16 42 0 25

Wisconsin 180 180 74 49 17 4 11

South 5,710 251 75 67 25 25 12

Alabama 329 291 91 71 32 25 13

Arkansas 146 268 92 79 17 21 4

Delawarec 63 178 29 33 26 43 11

Florida 813 249 59 78 17 41 8

Georgia 415 201 68 57 14 24 10

Kentucky 164 323 119 94 22 23 14

Louisiana 314 388 117 103 42 53 6

Maryland 287 246 65 63 26 55 13

Mississippi 180 273 80 77 13 13 3

North Carolina 297 199 61 56 19 22 6

Oklahoma 239 234 75 60 29 11 16

South Carolina 229 239 108 39 18 15 13

Tennessee 280 344 116 75 51 22 20

Texas 1,582 241 65 63 30 14 14

Virginia 319 240 73 65 31 24 12

West Virginia 53 326 189 82 7 0 14

West 2,383 181 43 50 29 9 8

Alaskac 34 111 53 17 6 0 6

Arizona 289 225 63 67 41 8 8

California 1,306 170 34 49 26 12 8

Colorado 180 202 39 34 58 ... 17

Hawaiic 36 124 33 19 38 5 5

Idaho 50 182 41 73 23 0 5

Montana 35 272 56 83 47 0 10

Nevada 107 227 75 65 12 12 5

New Mexico 53 181 53 53 25 0 17

Oregon 116 217 82 61 29 2 5

Utah 35 116 35 23 6 0 0

Washington 130 175 61 36 25 9 5

Wyoming 12 142 33 48 14 16 0

Note: All mortality rates were calculated based on custody populations for June 30 in each year.

... Data not reported due to State law prohibiting the release of named records related to AIDS-related 

deaths. For information on AIDS deaths in these States, see HIV in Prisons, 2004, <http://www.ojp.usdoj. 

gov/bjs/abstract/hivp04.htm>.

aExcludes influenza and pneumonia.

bExcludes nine total prisoner deaths reported by the District of Columbia in 2001. Two of these deaths were 

from heart disease; liver disease, AIDS, respiratory disease, and digestive disease each accounted for one 

death. The District of Columbia transferred all prisoner custody operations to the Federal Bureau of Prisons 

during 2001.

cPrisons and jails form one integrated system.
10 Medical Causes of Death in State Prisons, 2001-2004

Appendix table 10. Average annual mortality rate from leading causes of illness deaths, per 100,000 State prison inmates, 

among the States, 2001-2004

Average annual mortality rate, per 100,000 State prison inmates, 2001-04

All illnesses Heart diseases Cancer Liver diseases Respiratory diseases*

Five highest

Louisiana 388 West Virginia 189 Louisiana 103 Colorado 58 South Dakota 25

Tennessee 344 Kentucky 119 Kentucky 94 Tennessee 51 Tennessee 20

Pennsylvania 328 Louisiana 117 New Hampshire 92 Montana 47 Ohio 18

West Virginia 326 Tennessee 116 Montana 83 Louisiana 42 Colorado 17

Kentucky 323 Pennsylvania 115 West Virginia 82 South Dakota 42 New Mexico 17

Five lowest

Vermont 108 New Hampshire 10 Vermont 0 Rhode Island 0 Seven Sates 0

Alaska 111 Delaware 29 Connecticut 15 Alaska 6 (Maine, Massachusetts,

Iowa 111 Iowa 30 South Dakota 16 Utah 6 North Dakota, Rhode

North Dakota 116 Hawaii 33 Alaska 17 West Virginia 7 Island, Utah, Vermont,

Utah 116 Wyoming 33 Hawaii 19 Iowa 9 Wyoming)

Note: AIDS death rates are not listed because all States did not report AIDS deaths. For information on AIDS deaths by State, see HIV in Prisons,

2004, <http://www.ojp.usdoj.gov/bjs/abstract/hivp04.htm>.

*Excludes influenza and pneumonia.

Appendix table 11. Average annual mortality rate, per 100,000 residents, 

of State prisoners and U.S. residents, by selected characteristics

Average annual mortality rate, 

per 100,000 U.S. residents, 

age 15-64, 2001-03

Average annual mortality 

rate, per 100,000 State 

prisoners, 2001-04

All U.S. residents

All causes 308 250

All, excluding transportation deaths 289 ~

Gender

Male 387 257

Female 231 149

Race/Hispanic origin

White, non-Hispanic 312 343

Black, non-Hispanic 484 206

Hispanic 180 206

Age

15-24 81 34

25-34 105 64

35-44 203 179

45-54 430 560

55-64 952 1,481

Note: During the period 2001-2004, inmates age 15 to 64 made up 99% of the State 

prison population. Mortality data on U.S. residents are from the National Center for Health 

Statistics at the Centers for Disease Control and Prevention. See “Deaths: Final Data for 

2003,” National Vital Statistics Reports, Volume 54, Number 13, April 19, 2006, <http://

www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_13.pdf>.

~ Not applicable.
Medical Causes of Death in State Prisons, 2001-2004 11

Appendix table 12. Causes of death in State prisons, with International Classification of Disease, 10th revision 

(ICD-10) codes and average annual mortality rate per 100,000 inmates, 2001-2004

Cause of death (ICD-10 code range)

Number of deaths in 

State prisons 2001-04

Average annual 

mortality rate, per 

100,000 inmates 

2001-04

All causes 12,129 250

Heart diseases (I00-I09, I11, I13, I20, or I51) 3,314 68

Cancer (C00-C97) 2,820 58

Other liver diseases, excluding cirrhosis (K71-K72, K75-K77) 891 18

AIDSa 870 18

Suicidea 737 15

Cerebrovascular diseases (I60-I69) 394 8

Chronic liver disease (K70, K73-K74) 339 7

Other respiratory diseases (J00-J06, J30-J39, J67, J70-J98) 325 7

Illness — specific medical cause unknown (R00-R99) 269 6

Septicemia (A40-A41) 262 5

Influenza/pneumonia (J10-J18) 225 5

Nephritis, nephrosis, nephrotic syndrome (N00-N07, N17-N19, N25-N27) 193 4

Homicidea 188 4

Chronic lower respiratory diseases (J40-J47) 162 3

Alcohol/drug intoxication a 119 2

Accidental injurya 117 2

Unknown cause of deathb 115 2

Other diseases of the digestive system (K90-K93) 112 2

Viral hepatitis, all types (B15-B19) 82 2

Aortic aneurysm (I71-I78) 78 2

Diabetes mellitus (E10-E14) 59 1

Illness — multiple medical causes, unresolvedc 45 1

Other disorders of the nervous system (G90-G99) 34 1

Anemias (D50-D64) 26 1

Benign neoplasms, in-situ neoplasms (D00-D48) 26 1

Disorders of the gall bladder, biliary tract & pancreas (K80-K87) 25 1

Other diseases of the intestines (K55-K63) 25 1

Other causes/manners of death not listeda 23 <0.5

Diseases of the esophagus, stomach & duodenum (K20-K31) 22 <0.5

Atherosclerosis (I70) 17 <0.5

Mycoses (B35-B49) 17 <0.5

Diseases of the peritoneum (K65-K67) 17 <0.5

Metabolic disorders (E70-E90) 17 <0.5

Inflammatory diseases of the central nervous system (G00-G09) 17 <0.5

Episodic and paroxysmal disorders (G40-G47) 11 <0.5

Hypertension, hypertensive renal failure (I10-I12) 9 <0.5

Diseases of the veins, lymphatic vessels, lymph nodes (I80-I89) 9 <0.5

Lung diseases due to external agents (J60-J70) 8 <0.5

Systemic atrophies, primarily affecting the central nervous system (G10-G13) 8 <0.5

Congenital malformations, deformations (Q00-Q99) 8 <0.5

Systemic connective tissue disorders (M30-M36) 8 <0.5

Coagulation defects, purpura, other haemorrhagic conditions (D65-D69) 8 <0.5

Other/unspecified infectious diseases (B99) 7 <0.5

Tuberculosis (A16-A19) 6 <0.5

Noninfective enteritis and colitis (K50-K52) 5 <0.5

Protozoal diseases (B50-B64) 5 <0.5

Other bacterial diseases (A30-A39, A42-A49) 4 <0.5

Other disorders of the kidney and ureter (N28-N29) 4 <0.5

Alzheimer's disease (G30) 4 <0.5

Sequelae of infectious & parasitic diseases (B90-B94) 4 <0.5

Other diseases of the blood, blood-forming organs (D70-D77) 3 <0.5

Renal tubulo-interstitial diseases (N10-N16) 3 <0.5

Other disorders of the skin and subcutaneous tissue (L80-L99) 3 <0.5

Certain disorders involving the immune mechanism (D80-D89) 3 <0.5

Organic mental disorders (F00-F09) 3 <0.5

Hypotension & other/unspecified circulatory disorders (I95-I99) 3 <0.5

Obesity and other hyperalimentation (E65-E68) 2 <0.5

Demyelinating diseases of the central nervous system, multiple sclerosis (G35-G37) 2 <0.5

Other disorders of glucose regulation & pancreatic internal secretion (E15-E16) 2 <0.5

Mental & behavioral disorders due to psychoactive substance use (F10-F19) 2 <0.5
12 Medical Causes of Death in State Prisons, 2001-2004

Appendix table 12. continued

Cause of death (ICD-10 code range)

Number of deaths in 

State prisons 2001-04

Average annual 

mortality rate, per 

100,000 inmates 

2001-04

All causes 12,129 250

Parkinson's disease (G20-G21) 2 <0.5

Unspecified mental disorders (F99) 2 <0.5

Infections of the skin and subcutaneous tissue (L00-L08) 1 <0.5

Osteopathies and chondropathies (M80-M94) 1 <0.5

Arthritis — inflammatory polyarthropathies (M05-M14) 1 <0.5

Viral infections of the central nervous system (A80-A89) 1 <0.5

Helminthiases (B65-B83) 1 <0.5

Other disorders of the endocrine glands (E20-E35) 1 <0.5

Diseases of the appendix (K35-K38) 1 <0.5

Polyneuropathies & other disorders of the peripheral nervous system (G60-G64) 1 <0.5

Muscle disorders (M60-M63) 1 <0.5

Note: For the entire 4-year period, 66% of the illness death records specified a single medical cause of death. The medical causes listed 

in these cases were ranked by frequency for both male and female inmates. The medical cause of death for the remaining illness deaths 

was selected by choosing the most common cause listed, within gender.

aICD-10 codes were only used for deaths attributed to “illness/natural causes.” AIDS was a separate category under "cause of death." 

Any “illness/natural causes” which listed AIDS or HIV among the causes of death were recoded to “AIDS-related” deaths.

bCases were checked "other causes of death" with a text description of events, but the information was insufficient to classify the case to 

any single cause.

c

In all such cases, none of the causes of death matched the 63 medical causes of death cited in the single-cause cases of illness deaths.