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Association of census tract-level incarceration rate and life expectancy in New York State
  1. Louisa W Holaday1,2,
  2. Benjamin Howell3,4,
  3. Keitra Thompson1,2,
  4. Laura Cramer2,
  5. Emily Ai-hua Wang3,4
  1. 1 VA Connecticut Healthcare System, Department of Internal Medicine, West Haven, Connecticut, USA
  2. 2 National Clinician Scholars Program, Yale University, New Haven, Connecticut, USA
  3. 3 Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4 SEICHE Center for Health and Justice, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Louisa W Holaday, VA Connecticut Healthcare System - West Haven Campus, West Haven, CT 06520, USA; louisa.holaday{at}


Background Jail incarceration rates are positively associated with mortality at the county level. However, incarceration rates vary within counties, limiting the generalisability of this finding to neighbourhoods, where incarceration may have the greatest effects.

Methods We performed a cross-sectional analysis of census tract-level state imprisonment rates in New York State (2010) and life expectancy data from the US Small-area Life Expectancy Estimates Project (2010–2015). We modelled fixed-effects for counties and controlled for tract-level poverty, racial makeup, education, and population density from the American Community Survey (2010–2014), and violent crime data from the New York City Police Department (2010). We also examined interactions between incarceration rate and poverty, racial makeup, and population density on life expectancy.

Results Life expectancy at the highest quintile of incarceration was 5.5 years lower than in the lowest quintile, and over 2 years lower in a fully-adjusted model. Census tract-level poverty and racial makeup both moderated the association between incarceration and life expectancy.

Conclusion Census tract-level incarceration is associated with lower life expectancy. Decarceration, including alternatives to incarceration, and release of those currently incarcerated, may help to improve life expectancy at the neighbourhood level.

  • public health
  • poverty
  • neighborhood/place
  • health inequalities
  • psychosocial factors

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  • Contributors LWH had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: LWH and EAW. Acquisition, analysis or interpretation of data: LC, LWH, BH and EAW. Drafting of the manuscript and statistical analysis: LWH. Critical revision of the manuscript for important intellectual content: all authors. Supervision: EAW.

  • Funding LWH and KT are supported by the VA Office of Academic Affiliations through the VA/National Clinician Scholars Programme and Yale University. This publication was made possible by CTSA (grant number: TL1 TR001864) from the National Centre for Advancing Translational Science, a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. BH received funding from NIDA (grant number: 5K12DA033312), and in the past 36 months months. EA-hW received research support through Yale University from the Bureau of Justice Administration to study reentry by linking correctional and community health system data (grant number: 2015-RY-BX-K002) and the Substance Abuse and Mental Health Services Administration to study how to improve the health of women just released from corrections; and currently receives research support through Yale University from the National Cancer Institute of National Institute of Health (grant number: 1R01CA230444), the National Heart, Lung, and Blood Institute (grant number: 1R01HL137696), the National Institute of Minority Health and Disparities (1R01MD010403) and the National Institute of Drug Abuse (grant number: 1UG1DA050072) to study incarceration and cancer, cardiovascular disease, gun violence and opioid use disorder. She also receives funding from the William T. Grant Foundation to study health-related barriers and facilitators to reducing criminal legal contact and from the California Healthcare Foundation to evaluate the Transitions Clinic Network in California.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.