Key papers comparing mortality from COVID-19 in PEI versus the general population
| Study | Key results | Overall assessment of the quality of evidence | Mortality outcomes in PEI vs general population |
| A time-series analysis of testing and COVID-19 outbreaks in Canadian federal prisons to inform prevention and surveillance efforts. Blair et al29 | Case fatality was 0.6% in prisons compared with estimated 10% in general population | Low | ↓ |
| Adverse SARS-CoV-2-associated outcomes among people experiencing social marginalisation and psychiatric vulnerability: a population-based cohort study among 4,4 million people. Nilsson et al42 | aIRR Death within 60 days of COVID-19 diagnosis 3.11 (95% CI 1.93 to 5.03, p≤.0001). Rate of all cause mortality rate ratio over study period 9.44 (95% CI 6.43 to 13.88, p≤.0001) in prison residents with COVID-19 infection vs 4.00 (95% CI 3.87 to 4.13, p≤.0001) in the general population with COVID-19 infection | Medium | ↑ |
| Age and COVID-19 mortality in the United States: a comparison of the prison and general population. Nowotny et al60 | Increased standardised mortality ratio of 2.89 (95% CI 2.78 to 3.00) in the prison population vs general population. Prison residents died at younger ages than the general population | Low | ↑ |
| Assessing the mortality impact of the COVID-19 pandemic in Florida state prisons. Marquez et al61 | Increase in mortality in 2020 when compared with 2019 for prisoners (aRR 1.56 (95% CI 1.39 to 1.76) compared to 2019 when using bootstrapping), Monthly median posterior estimates of excess mortality were found to be strongly and significantly correlated with monthly reported deaths related to COVID-19 (80.4%, p<.01), life expectancy decreased by 4.12 years between 2019 and 2020 | Medium | ↑ |
| Characteristics and comparative clinical outcomes of prisoner vs non‐prisoner populations hospitalized with COVID‐19. Altibi et al14 | In-hospital mortality was higher for prisoners with an adjusted OR of 2.32 (95% CI 1.33 to 4.05 statistically significant) (adjusted for age, sex, race, CCI and obesity) | Medium | ↑ |
| Characteristics and outcomes of prisoners hospitalized due to COVID-19 disease. Abdalbary et al55 | No significant difference in mortality of hospitalised patients with kidney involvement compared with the general population | Low | ⇆ |
| COVID-19 case and mortality rates in the Federal Bureau of Prisons. Toblin and Hagan26 | SMR for age and sex was 2.6 for prisoners compared with general population | Medium | ↑ |
| COVID-19 cases and deaths in federal and state prisons. Saloner et al27 | Crude death rate not statistically different, SMR in PEI adjusted for age and sex = 3.0 versus general population | Low | ↑ |
| COVID-19 in prisons: state health care contracting and the pandemic behind bars. Smith and Glidden39 | Lower mean COVID-19 deaths per 10 000 (3.67, range 0–25) in the incarcerated population compared with the general population (COVID-19 deaths per 100 000 66.04 1.34–1646.11) Incarcerated residents in states who provide at least some healthcare from Department of Correction staff (as opposed to purely privately contracted healthcare) showed significantly reduced COVID-19 deaths per 100 000 (b=−3.47, p=.04) Average expenditure on healthcare per incarcerated resident had no significant effect on COVID-19 rates or mortality | Low | ↓ |
| COVID-19 incidence and mortality in federal and state prisons compared with the US population, April 5, 2020 to April 3, 2021. Marquez et al28 | SMR was 2.5 (95% CI, 2.3 to 2.7) in PEI versus general population | Medium | ↑ |
| Disparities in COVID-19 related mortality in U.S. prisons and the general population. Nowotny et al58 | adjusted SMR (for age and sex) was 2.75 in comparison to the general public, crude mortality rate of 50/10 000 in prisons compared with 40/10 000 in general public, SMR varied hugely between states, with some states going up to 10.56 that of the general population | Low | ↑ |
| Epidemiology of COVID-19 in prisons, England. 2020 Rice et al38 | CFR= 3.13% (95% CI 2 to 4.67) in prisons compared with in 8% in England over study time, CFR for over 66 in prison was 15.5% but no comparison to the over 66s in the general public | Low | ↓ |
| Hospitalizations for COVID-19 among US people experiencing incarceration or homelessness. Montgomery et al54 | People experiencing incarceration more likely to die in hospital than general population following COVID-19 related admission (aRR, 1.28; 95% CI 1.11 to 1.47) | Medium | ↑ |
| Indirect age- and sex-standardisation of COVID-19-related mortality rates for the prison population of England and Wales. Braithwaite et al13 | SMR = 3.3 (95% CI 2.77 to 3.98) in PEI versus general population | Medium | ↑ |
| Life expectancy and COVID-19 in Florida state prisons. Marquez et al59 | Standardised COVID-19 mortality rate for the incarcerated population was 4.45 times that of the general population (203.9 deaths per 100 000—IRR=4.45, 95% CI 3.85 to 5.15, p<.001). COVID-19 contributed to a reduction of life expectancy in the incarcerated population of 4.2 years vs 1.5 years in the general population. In 2020, the standardised mortality rate of the incarcerated population was 626.9 deaths per 100 000 individuals vs 597.3 deaths per 100 000 individuals in the general population | Low | ↑ |
| SARS-CoV-2 among inmates aged over 60 during a COVID-19 outbreak in a penitentiary complex in Brazil: positive health outcomes despite high prevalence. Gouvea-Reis et al63 | 0% mortality rate in the sampled population (159 residents with 90.6% test positivity rate). Per reported general population data for the Federal District of Brazil, mortality rate is lower than expected—per reported positive test numbers in the penitentiary, the following numbers of deaths per age group would be expected: 60–69=6.032 deaths, 70–79=2.875 deaths, 80+=1.38 deaths | Low | ↓ |
| Testing lags and emerging COVID-19 outbreaks in federal penitentiaries: a view from Canada. Blair et al53 | Case fatality estimates of 0.5% in prisons compared with 0.3% in general population | Low | ↑ |
aIRR, adjusted incidence rate ratio; aRR, adjusted risk ratio; CCI, Charlson Comorbidity Index; CFR, Case Fatality Ratio ; IRR, incidence rate ratio; PEI, people experiencing incarceration; RR, risk ratio; SMR, standardised morality rates.