by David M. Reutter

Thousands of people die in local jails annually. The causes of death vary, leading researchers to seek identifiable trends. A report published by the National Institutes of Health (NIH) on December 19, 2023, found an underlying risk of mortality traced to “a heavy reliance on incarceration: the cycling of people into and out of jails where the impacts of addiction, mental illness, and health inequity can be exacerbated with dire consequences.” The nonprofit Prison Policy Initiative (PPI) then issued an update on April 15, 2024, to an earlier analysis of local jail data, concluding that little has changed since that 2017 look at overuse of jails in the U.S.

Authored by Jessica L. Adler and Weiwei Chen, the NIH report used data from the federal Bureau of Justice Statistics (BJS) to assess mortality rates and conditions in about 450 local jails between 2008 and 2019. In the latter year alone, there were some 10.3 million admissions to jails which the study called “the front door of the criminal justice system.” Of the 734,500 people serving time in U.S. jails in 2019, two-thirds were pretrial detainees—a group which also comprised 76% of jail deaths.

Jails are diverse in “terms of size, conditions, oversight, and demographics.” At least 30% of detainees are “significantly poorer” than people outside jails, leaving them at “heightened risk” of incarceration because they cannot afford to post bond. As of 2019, Blacks were jailed at a rate three times higher than whites. Hispanics were also disproportionately subject to pretrial confinement.

Medical services in jails are also strained, since pretrial detainees often present themselves to jail with drug or alcohol addiction and withdrawal issues or with chronic or infectious medical conditions that are often mismanaged or untreated.

“A particular health risk—dying while incarcerated—became more commonplace during the period 2000-19,” wrote Adler and Chen, as jail mortality shot up 11%, deaths related to drug or alcohol abuse “almost quintupled,” and the suicide rate “hovered at more than double the adjusted national average.” Moreover, while “mortality due to some illnesses fell,” the report found “there were increases in deaths due to heart disease and cancer.”

Adler and Chen looked at mortality data for 523 jails or jail systems provided by Reuters. Jail admission data came from BJS’s 2013 and the 2019 Census of Jails data and its Annual Survey of Jails data from the 2008-18 period. The data indicated troubling trends.

“On average, about 1.40 deaths occurred annually per 1,000 incarcerated people,” of which 0.62 were “illness-related deaths,” 0.53 were suicides, and 0.15 were “acute drug- or alcohol-related deaths,” Adler and Chen found. “Accidents or homicides were less common (0.03 deaths each). The daily population was close to 1,000 people per facility. The average turnover rate was about 67 percent, and the capacity occupied was more than 90 percent.”

Importantly, Adler and Chen concluded that “jails with higher turnover rates were likely to have higher overall mortality than jails with lower turnover.” Deaths due to suicide, homicide, drugs and alcohol showed “a significant association with high turnover.” In 2019, the average jail stay was six days, but “[d]uring the period 2000-19, the median time served before a drug- or alcohol-related death was one day,” versus “nine days before a suicide death” and “thirty days before a homicide death.”

Suicide was the leading cause of jail deaths in 2019, with a rate that was “more than double both the adjusted national average and the suicide rate in prisons,” Adler and Chen found. “As prior studies suggest and our results show, cycling higher numbers of people into and out of jails relates to more fatalities.”

BJS data showed that length of stay increased with jail size, and illness-related deaths are associated with the largest jails. Adler and Chen found that medium-sized jails experienced higher rates of illness-related deaths than smaller jails, as well as “higher rates of drug- or alcohol-related deaths than either smaller or larger jails.” Yet they estimated that just 34% of jails provide detox services, and “even fewer offer maintenance pharmacotherapy.”

Black detainees were more likely to die of illness-related deaths, especially in larger jails. A higher proportion of females and juveniles in a jail was also associated with increased deaths. Privatized medical services led to more deaths, too. “Our results indicate,” the authors wrote, “that health care in jail that is overseen by a public provider, as opposed to a private provider or a hybrid of the two, is related to lower mortality due to suicide.”

When one out of every three Americans faces incarceration at some point during his or her life—and jail populations remain stagnant despite advocates’ efforts to reduce the number of people held in pretrial detention —understanding jail mortality must become a public priority. See: Jail Conditions And Mortality: Death Rates Associated With Turnover, Jail Size, And Population Characteristics, NIH (Dec. 2023).

PPI’s report, Era of Mass Expansion: Why State Officials Should Fight Jail Growth (2017), examined drivers of jail incarceration and how jails impact the entire criminal justice system and millions of lives annually. Since it was issued, many jurisdictions have passed reforms aimed at reducing jail populations. Yet PPI’s recent update found the same trends continue to increase jail populations.

Among those trends: the perverse practice of renting out jail space, which fuels jail growth. Some jurisdictions have financed and built jail bed space they don’t need but expect to rent to other jurisdictions or to federal agencies, such as the U.S. Marshals Service (USMS) and federal Immigration and Customs Enforcement (ICE). USMS rents about 26,000 jail beds each year. ICE rents about 15,700 more. The practice “both skews the data and gives local jail officials a powerful incentive to endorse policies that contribute to unnecessary jail expansion,” PPI wrote.

Renting of jail beds to other jurisdictions—“while also building ever-larger facilities in order to cash in on that market”—alters policy priorities for jail officials, the report noted, leaving “little incentive to welcome or implement reforms.” As jails continue to experience overcrowding and high turnover, the trend of higher death rates will likely continue.