Mass Incarceration and Community Health

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

Capstone Advisor: James Plumb, MD, MPH, Thomas Jefferson University


The objective of this study is to determine the relationship between rates of incarceration and population health outcomes in counties across the US. A database was constructed linking health indicator, mortality, demographic and correctional system data for all counties in the US. Data sources included Community Health Status Indicators (1999-2007), Centers for Disease Control mortality tables (1999-2010), jail incarceration data from the Bureau of Justice Statistics (BJS) Annual Survey of Jails (2000-2012), the US Census Bureau and the Kaiser Family Foundation. The unit of analysis was at the county level, with all US counties or subsets considered, depending on the particular analysis. Bivariate and partial correlations were conducted to explore potential associations between incarceration, demographic factors and community health outcomes, and to inform variables for inclusion in a multivariate model. Variables having the most substantial and significant associations with incarceration rates were infant mortality (r=.524, p<.001), low birth weight (r=.521, p<.001), death due to stroke ( r=.502, p<.001), average life expectancy (r= -.537, p <.001) and poverty (r=.546, p<001). Infant mortality demonstrated a significant association with incarceration rates each year from 2006 to 2010. Controlling for poverty rate attenuated but did not eliminate the significance of the association. Multiple regression analysis incorporating several demographic and health outcome measures was conducted, with poverty and infant mortality accounting for the greatest variance in the model (R-square=.517, p<.001). As one of the potential causes for increased incarceration rates, mental health services expenditures by state were found to have a significant negative correlation with rates of incarceration (r=-.494, p=.001; unit of analysis at the state level). The data demonstrate significant associations between rates of incarceration and infant mortality in US counties, suggesting a central role of concentrated incarceration in adverse health outcomes. In addition, the analyses provide evidence supporting decreased mental health services as a factor in the growth of jail populations.

Presentation: 36 minutes