Incarceration Rates and Birth Outcomes in U.S. Counties: Policy Implications

Joe Hulihan, MD, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA


JD Plumb, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.


The rate of incarceration in the US is highest in the world, with a disproportionate burden falling on African-Americans, particularly young men. Several investigators have demonstrated adverse behavioral and physical health effects for individuals, families and communities. Two recent studies demonstrated associations of paternal incarceration with elevations in infant mortality. This study will assess the relationship between rates of incarceration and infant mortality at a US county level, and the role of potential contributing factors. Data on subsets of counties from 2005 (N = 349) and 2010 (N = 129) were analyzed. Multivariate regression of infant mortality on incarceration rate, percent below poverty, percent African-American race; percent without health insurance, late/no prenatal care (2005 only) or fair/poor health, was statistically significant for both data sets [R2 = .581p < 001 (2005); R2 = .427, p < 0.01 (2010)]. Individual standardized coefficients were significant for poverty, African-American race and incarceration rate using either 2005 data (β = .28, p < .001; β = .14, p < .001; and β = .07, p < .05, respectively) or 2010 data (β = .51, p < .001; β = .08, p = .001; β = .19, p < .01, respectively). A subset of counties was characterized by high infant mortality closely concordant with local incarceration rate (2005 data).

The results support and extend previous research, showing a robust association of poverty, race and concentrated incarceration with infant mortality in a nationwide sample of US counties. Policymakers should consider the association of incarceration and birth outcomes in the context of population health as well as criminal and social justice. Research and intervention programs could maximize efficiency by considering areas where incarceration and poor birth outcomes are more prevalent and highly concordant.

Presentation: 38 minutes