Safer Behind Bars? Comparing In-Custody Deaths Prior to and During Incarceration

Introduction: This project aims to characterize trauma-associated deaths of the American incarcerated population through legal intervention (LI) or death by law enforcement officials while in custody before and during incarceration. We determined the preceding events leading to violent death, including initiation of medical care, use of restraints and force, and demographics of the victims.

Methods: We used National Violent Death Reporting System data from the years 2003-2019 to identify deaths that occurred while in custody or incarcerated, including discriminate and narrative data. Event information included weapon type, location of death, incident type, incarceration status, use of restraints, and prone positioning.

Results: There were 86 victims who died from LI included in the analysis. Most events occurred after incarceration. All victims in our cohort were male, and race was an associated factor for death by LI. Only 16% of victims had an education level above high school/general educational development. Death by firearm compared to other weapons was significantly more common in the in-custody but not yet incarcerated group (83% versus 42%, P ≤ 0.0001). Other associated factors included a history of mental health, physical confrontations, the belief that the victim had a weapon, and being restrained in prone positioning.

Conclusions: Our study shows that racial minority victims are disproportionately affected by LI deaths. Firearms and restraint type were important factors in LI deaths. Our findings suggest that violence prevention in the justice system should focus on prevention and de-escalation across setting with specific attention to use of force and inmate access to the weapons of police, guards, and other law and justice system workers. More transparent quality data is sorely needed to adequately define and address this problem.