The Consequences of Sanctions for Mortality in Socially Marginalized Populations A large body of research has documented persistent social inequality in health between groups defined by race/ethnicity and socioeconomic status (SES), showing that minorities and groups of lower SES have lower life expectancy, greater risk of mortality at all ages, and earlier onset and greater severity of many chronic diseases, even after adjusting for differences in health care access and health behaviors. Advancing our scientific understanding of such disparities and formulating effective responses to them requires research designed to investigate key aspects of the social environment that are linked to race/ethnicity and SES. One of the biggest social changes to have a disproportionate impact on minorities and people of lower SES in the United States in recent years has been the 705% increase in the size of the incarcerated population over the last four decades. Yet relatively little research has investigated the effects of incarceration on health and health disparities, in part because the incarcerated population is underrepresented in most data used to study health and mortality. The current project will examine the effects of incarceration on the risk of mortality, using data on the population of all individuals sentenced to felonies in Michigan from 2003 to 2006 (nH130,000). We propose to (1) match these individuals to death records from the National Death Index, (2) estimate the causal effects of incarceration using a pair of quasi-experimental designs, and (3) explore heterogeneity in the impact of incarceration on mortality across subgroups of offenders and by cause of death. One quasi- experimental design uses the random assignment of judges to felony cases as an instrumental variable that exogenously influences the type of sentence a convicted offender receives. The other is a regression discontinuity design that exploits discontinuities in how (a) criminal history and (b) offense severity determine the probability of being sentenced to prison according to MI's sentencing guidelines. The significance of the project stems from its focus on the health needs of two large and understudied populations: those who serve time in institutional corrections (prison and jail) and the even larger group of offenders who are supervised in the community on probation. Its main innovations are (1) compiling longitudinal data that can be used to study the effects of incarceration on a large statewide cohort of felony offenders, (2) defining appropriate comparison groups to study the effects of incarceration (a major limitation of prior studies), (3) utilizing a pair quasi- experimental designs to identify causal effects (thus addressing problems of unobserved confounding that have plagued prior studies), and (4) assembling an expert and interdisciplinary research team consisting of sociologists (Morenoff and Harding) who have studied the MI corrections population, a medical researcher/practitioner (Binswanger) who is a leading scholar on incarceration and health, and an economist (Smith) with expertise on causal analysis of quasi-experimental designs.
A large body of research has documented persistent social inequality in health, showing that minorities and groups of lower socioeconomic status (SES) have lower life expectancy and greater risk of mortality throughout the lifespan, even after adjusting for differences in health care access and health behaviors. Incarceration in prison, which has increased dramatically in the US over the last four decades, is one social factor that may contribute to differential mortality by race/ethnicity and SES. The proposed project will examine the effect of incarceration in prison on mortality compared to alternative sentences (jail and probation), providing insight on possible points of intervention to improve health among prisoners, former prisoners, or probationers - vulnerable populations with significantly worse health than the general population.