How Many People Die in Prison a Year? Causes and Undercounts

At least 6,182 people died in U.S. state and federal prisons in 2020, a 46% increase over the year before, driven almost entirely by COVID-19.¹ In a typical pre-pandemic year the total is lower but still substantial: 4,234 deaths in state and federal facilities in 2019, most of them from illness.² How many people die in prison a year depends on which year you look at and how well the states are reporting, and by any honest reading the published numbers are a floor rather than a ceiling.

Annual Death Counts and Recent Trends

The 2019 total broke down to 3,853 deaths in state prisons and 381 in federal prisons.² The following year the combined figure jumped to at least 6,182, with roughly 2,500 deaths attributed to COVID-19 between March 2020 and February 2021. Eighty-three percent of the pandemic-related deaths were people aged 55 or older.³

For federal facilities alone, the Bureau of Justice Statistics counted 483 deaths in custody during fiscal year 2022, the most recent federal figure available.⁴ Comprehensive state-level data runs several years behind, so the full national picture after 2020 is still coming into focus.

Leading Causes of Death Behind Bars

Illness dominates. In 2018, illness accounted for 87% of state prison deaths and 90% of federal prison deaths. Cancer alone killed 1,137 state prisoners that year, and heart disease killed 1,052.⁵ Both conditions demand consistent screening and long-term treatment, which are harder to deliver inside a prison than outside one. Research cited by BJS has found that incarcerated people age physiologically faster than their peers; a 59-year-old in prison can carry the morbidity profile of a 75-year-old on the outside.

Suicide

Suicide was the second-leading cause of death in prisons and the leading cause of death in local jails in 2019.⁶ State prison suicides climbed 85% between 2001 and 2018, from 168 to 311. Across that span, suicide accounted for about 6% of state prison deaths and nearly 5% of federal prison deaths.⁵ In jails the danger is front-loaded: nearly half of people who died by suicide had been held for seven days or less, and two-thirds died within their first 30 days.

Drugs, Alcohol, and Homicide

Drug and alcohol intoxication deaths in state prisons quintupled from 50 in 2014 to 249 in 2018, mirroring the overdose crisis outside. Homicides made up 2% of state prison deaths and about 3% of federal prison deaths between 2001 and 2018. The annual state prison homicide count tripled over that period, from 39 in 2001 to 120 in 2018.⁵

A Department of Justice Inspector General evaluation covering federal prisons from fiscal year 2014 through 2021 recorded 187 suicides, 89 homicides, and 56 accidental deaths. Federal suicides rose from 22 in FY2014 to 31 in FY2021.⁷

How Prison Mortality Compares to the General Population

After adjusting for sex, race, ethnicity, and age, state prisoners died at a lower overall rate than the adult U.S. population in 2019: 308 per 100,000 versus 435 per 100,000.² Prisoners can’t die in car crashes or most industrial accidents, and their access to drugs and alcohol is restricted, if hardly eliminated.

The categories where prisoners die at higher rates point to the specific hazards of confinement. In 2019, the state prison cancer death rate ran slightly above the outside rate (88 vs. 83 per 100,000), the suicide rate was higher (25 vs. 22), and the homicide rate was almost triple (11 vs. 4).² Violence, mental health crises, and delayed treatment for serious disease are what the confinement setting adds.

How the Facility Type Changes the Odds

State Versus Federal Prisons

In 2019, state prisons had a mortality rate of 330 per 100,000, while federal prisons came in at 259 per 100,000.² The gap partly reflects who’s inside. State systems hold more people serving life or decades-long terms, so a larger share of the population reaches the ages where chronic disease becomes deadly.

Local Jails

Jails carry a different risk profile. The average jail stay in 2019 was just 26 days, and the churn of admissions and releases creates its own dangers.⁸ Jail suicide rates run more than double the prison rate.⁶ People arriving at a jail are often in acute crisis: withdrawing from drugs or alcohol, experiencing untreated mental illness, or reeling from arrest. The median time from admission to a drug- or alcohol-related death in jail is one day. For suicide, it’s nine.

A Reuters data analysis of 2008 through 2019 found that jails using private healthcare providers had death rates 18% to 58% higher than jails where medical care was managed by the sheriff’s office or a local health department. Publicly managed jails averaged 12.8 deaths per 10,000 inmates; jails with private healthcare saw an additional 2.3 to 7.4 deaths per 10,000, depending on the company.

Who Dies: Age, Sex, and Race

Age is the single strongest predictor. In 2018, the mortality rate for state prisoners aged 18 to 24 was 58 per 100,000. For those over 54, it was 1,606 per 100,000, roughly 28 times higher.⁵ Longer sentences, mandatory minimums, and reduced parole opportunities have pushed more people into old age behind bars, and prison healthcare systems weren’t built to function as nursing homes.

Male prisoners die at substantially higher rates. In 2018, the state prison mortality rate was 356 per 100,000 for men and 203 per 100,000 for women, and about 95% of state prisoners who died in 2019 were male.⁵ On race, more than half of state prisoners who died in 2019 were non-Hispanic white, which roughly tracks the demographic composition of the state prison population. During the first year of COVID-19, the racial breakdown of deaths was 44% white, 34% Black, and 14% Hispanic.³

Why the Official Counts Are Almost Certainly Low

The national data source is the Bureau of Justice Statistics’ Mortality in Correctional Institutions program, formerly the Deaths in Custody Reporting Program, which began collecting after Congress passed the Death in Custody Reporting Act in 2000.⁹ States are required to report quarterly on every death in local jails, state prisons, and during arrest.¹⁰

Compliance has been poor. A 2022 Government Accountability Office review found that 70% of the death records states submitted for fiscal year 2021 were missing at least one legally required piece of information, and about 40% lacked any description of the circumstances surrounding the death. The GAO also identified nearly 1,000 deaths that should have been reported but weren’t, and four states that accepted federal grant funding reported zero deaths despite deaths occurring in their facilities.¹¹ Noncompliant states can lose up to 10% of their Justice Assistance Grant funding, but as of the GAO’s review the Department of Justice had not determined whether any state was actually noncompliant for fiscal years 2020 or 2021.

The practical upshot: every number above almost certainly undercounts the real toll. When the reporting system can’t confirm it’s receiving all the reports, the published totals are a floor.

1
Bureau of Justice Statistics. Prisoners in 2020 – Statistical Tables
2
Bureau of Justice Statistics. Mortality in State and Federal Prisons, 2001-2019 – Statistical Tables
3
Bureau of Justice Statistics. Impact of COVID-19 on State and Federal Prisons, March 2020-February 2021
4
Bureau of Justice Statistics. Federal Deaths in Custody and During Arrest, 2022 – Statistical Tables
5
Bureau of Justice Statistics. Mortality in State and Federal Prisons, 2001-2018 – Statistical Tables
6
Bureau of Justice Statistics. Suicide in Local Jails and State and Federal Prisons, 2000-2019 – Statistical Tables
7
U.S. Department of Justice Office of the Inspector General. Evaluation of Issues Surrounding Inmate Deaths in Federal Bureau of Prisons Institutions
8
National Center for Biotechnology Information (NCBI). Jail Conditions And Mortality: Death Rates Associated With Turnover, Jail Size, And Population Characteristics
9
Bureau of Justice Statistics. Mortality in Correctional Institutions (MCI) (Formerly Deaths in Custody Reporting Program (DCRP))
10
Bureau of Justice Assistance. Death in Custody Reporting Act – Reporting Guidance and FAQs
11
U.S. Government Accountability Office. Deaths in Custody: Additional Action Needed to Help Ensure Data Collected by DOJ Are Utilized