Cancer-related mortality of incarcerated populations in the United States.

Abstract

11050 Background: The United States has the largest incarcerated population of any country in the world with 1.2 million prisoners as of 2022, but little research has fully characterized the disease burden in these incarcerated populations. Due to the increasing size and age of the prison population, it is paramount to better understand causes of mortality in inmate populations. Methods: Mortality data was collected from 41 states via UCLA’s Behind Bars Data Project. 40,922 deaths were were recorded between 1999 and 2021, however, only 16,477 deaths had a specific cause of death. To account for individuals with unknown cause of death, analysis was conducted only on the cohort with a known cause of death. From this cohort, one Medical Student and two General Surgery Residents reviewed the death records and assigned each individual into one of 25 mechanisms of death. Protocol for this manual sorting of data was reviewed by the Surgical Health Outcomes and Reaching for Equity group (SHORE). This multidisciplinary group consists of statisticians, public health researchers, Surgery residents, and attending surgeons. Results: Of the 25 mechanisms of death, cancer was the leading cause accounting for 4,351 deaths. Approximately 26 different types of cancer were identified with the incarcerated population. The most common types of malignancies within this population were Lung, Hepatic/Biliary, Colorectal, and Esophageal cancers. The rates of Lung, Hepatic/Biliary, and Esophageal Cancer were significantly higher in the incarcerated population compared to the general population. Both the mean and median age of death in the incarcerated population was 61 years old (IQR 54-68), 37.6% were White, 21.3% were Black, 7.1% were Hispanic, and 35.8% unknown. In contrast, cancer related deaths accounted for a smaller proportion of deaths in the general population at 17.5% and 18.5% in 2021 and 2022 respectively. Conclusions: This analysis is the first of its kind to stratify mortality by cancer type within the prison population. Previous research that indicates prisoners have a high incidence of Hepatitis B due to the prevalence of IV drug use which is a major risk factor for Hepatic/Biliary cancer. Furthermore, incarcerated populations have higher rates of tobacco use compared to the general population which may account for some of the difference in Lung cancer rates. Delayed access to care in the prison environment may contribute to later diagnosis and correspondingly higher mortality rates among incarcerated individuals. Our results highlight the importance of access to care for effective cancer treatment, and the importance of understanding risk factors for cancer. Type of Cancer Deaths in Prison % in Prison Estimated Deaths in General Population % in General Population Difference Lung 1041 23.9% 125,070 20.4% 3.5% Hepatic/Biliary 600 13.8% 29,840 4.9% 8.9% Colorectal 363 8.3% 53,010 8.7% -0.4% Esophageal 325 7.5% 32,240 5.3% 2.2%