Association of Jail Incarceration With Lung, Liver, and Colorectal Cancer Mortality Across US Counties

Over 10 million jail admissions occur each year in the United States. Whether county-level incarceration shapes population-level cancer mortality remains unclear. We assessed county jail incarceration rates in relation to lung, liver, and colorectal cancer deaths.

This ecological study linked county incarceration rates (1995-2018, Vera Institute) with age-adjusted cancer mortality from the National Vital Statistics System (2000-2019). Incarceration was grouped into lagged quartiles (Q1 lowest; Q4 highest). Pooled Poisson regression with county-clustered robust errors estimated adjusted incidence rate ratios (aIRRs) while controlling for sociodemographic, behavioral, health care, and structural factors. Sex- and race-stratified analyses and longer exposure lags tested robustness.

Relative to Q1, Q4 counties had higher mortality from lung (aIRR, 1.08 [95% CI, 1.04 to 1.12]), liver (aIRR, 1.10 [95% CI, 1.00 to 1.22]), and colorectal (aIRR, 1.09 [95% CI, 1.04 to 1.15]) cancers. Among men, liver cancer deaths rose 13% in Q4 (aIRR, 1.13 [95% CI, 1.03 to 1.24]). Black residents experienced elevated lung and colorectal mortality across all incarceration quartiles and a 29% increase in liver cancer deaths in Q4 (aIRR, 1.29 [95% CI, 1.04 to 1.61]); excess mortality among White residents emerged only in Q4 counties (all P < .05). Findings persisted in sensitivity analyses.

Counties with the highest jail incarceration rates had 7%-10% more lung, liver, and colorectal cancer deaths with disproportionate impacts on men and Black residents. Incarceration operates as a structural driver of cancer disparities; targeted prevention, screening, and treatment efforts are urgently needed in high-incarceration communities.