In the United States, former incarceration is a risk factor for chronic conditions and sudden death (SD) due to poor healthcare continuity after release and lack of community support. During the COVID-19 pandemic, all-cause mortality increased, and preexisting risk factors and social limitations of having an incarceration history were exacerbated. We hypothesized that sudden deaths among the formerly incarcerated increased during the pandemic.
North Carolina death certificates from pre-COVID-19 (2014) and during the COVID-19 pandemic (2020) were screened for presumed SD. Individuals were excluded based on age ($<18$ or $>65$), violent or expected deaths, and deaths in hospitals or care facilities. Deaths were matched to the North Carolina Department of Public Safety Criminal Offender Database for a history of incarceration. ICD-10 codes for hypertension, diabetes, chronic respiratory disease, obesity, mental health, and substance abuse were extracted from the top four causes of death on the death certificates.
We found no significant difference in the prevalence of former incarceration in SD victims from 2014 to 2020. In 2020, the odds of substance abuse among SD victims with a history of incarceration were significantly greater compared to those without a history of incarceration (OR (95CI): 2.29 (1.91-2.73)). The odds of substance abuse among the formerly incarcerated were greater in 2020 SD victims compared to 2014 SD victims (2.29 (1.76-2.99)).
Sudden death among the formerly incarcerated did not significantly increase during the COVID-19 pandemic. Increased public health funding may have limited the expected effects of COVID-19 on rates of sudden death in formerly incarcerated individuals. However, the formerly incarcerated appear to be vulnerable to dying of sudden death associated with substance abuse in 2020. Improving statewide transition programs targeting substance abuse counseling during healthcare crises should improve health outcomes and reduce the rate of sudden death among the formerly incarcerated population.