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Ann Epidemiol. 2011 Oct;21(10):719-26. doi: 10.1016/j.annepidem.2011.04.007. Epub 2011 Jul 7.

All-cause and cause-specific mortality among black and white North Carolina state prisoners, 1995-2005.

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  • 1Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.



We compared mortality rates among state prisoners and other state residents to identify prisoners' health care needs.


We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among black and white male prisoners ages 20-79 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number on the basis of death rates among state residents.


The all-cause SMR of black prisoners was 0.52 (95% confidence interval, 0.48-0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease, and cancer. The all-cause SMR of white prisoners was 1.12 (95% confidence interval, 1.01-1.25) with fewer deaths than expected for accidents but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV.


The mortality of black prisoners was lower than that of black state residents for both traumatic and chronic causes of death. The mortality of white prisoners was lower than that of white state residents for accidents but greater for several chronic causes of death. Future studies should investigate the effect of prisoners' preincarceration and in-prison morbidity, the prison environment, and prison health care on prisoners' patterns of mortality.

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