Homicide Mortality in Formerly Incarcerated People Compared to the General Population in North Carolina, 2000 to 2020

People who have been incarcerated are known to be at high risk of homicide victimization, or dying from homicide, after release. However, limitations in study size and duration of follow-up in prior research have prohibited the identification of particularly high-risk groups and post-release time periods, and evaluation of more recent trends is warranted. We aimed to thoroughly describe post-release homicide trends in North Carolina over a twenty-year period.

In a retrospective cohort study, we linked records of 266,400 people released from NC state prisons between January 1, 2000 and March 1, 2020 to NC death certificate records to calculate homicide rates in the formerly incarcerated and NC general populations. Stratified rates and standardized mortality ratios (SMRs) were calculated by year and demographic subpopulations.

One year after release, formerly incarcerated people had 8.2 (95% CI: 7.5, 8.8) times the homicide deaths of the general population. There was little reduction over time; five years after release, the homicide SMR compared to the general population remained at 7.7 (7.3, 8.1). Black, Native, young adult, and male individuals were at extremely high risk. Rates have increased in recent years and the highest-risk periods have changed since 2014 due to increases in immediate-term post-release deaths.

Formerly incarcerated people are at high risk of homicide death both immediately after release and for at least five years after. The extreme racialized disparities in post-release homicide mortality warrant targeted intervention, particularly to reduce immediate-term homicide death among Black males.