• Alex Rothman, Shannon McConville, Renee Hsia, Lia Metzger, Cyrus Ahalt, and Brie A Williams.
• 1 Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
• Palliat Med. 2018 Jan 1; 32 (1): 172217-22.

BackgroundIncarcerated populations worldwide are aging dramatically; in the United States, prisoner mortality rates have reached an all-time high. Little is known about the incarcerated patients who die in community hospitals.AimCompare incarcerated and non-incarcerated hospital decedents in California.DesignCross-sectional study.Setting/ParticipantsAll state hospital decedents ( N = 370,831) from 2009 to 2013, decedent age over time examined with additional data (2001-2013).ResultsOverall, 745 incarcerated and 370,086 non-incarcerated individuals died in California hospitals. Incarcerated decedents were more often male (93% vs 51%), Black (19% vs 8%) Latino (27% vs 19%), younger (55 vs 73 years), had shorter hospitalizations (13 vs 16 days), and fewer had an advance care plan (23% vs 36%, p < 0.05). Incarcerated decedents had higher rates of cancer, liver disease, HIV/AIDs, and mental health disorders. Cause of death was disproportionately missing for incarcerated decedents. The average age of incarcerated decedents rose between 2001 and 2013, while it remained stable for others.ConclusionPalliative care services in correctional facilities should accommodate the needs of relatively young patients and those with mental illness. Given the simultaneous growth in the older prisoner population with the rising age of incarcerated hospital decedents, community hospital clinicians should be prepared to care for seriously ill, incarcerated patients. Significant epidemiologic differences between incarcerated and non-incarcerated decedents in this study suggest the importance of examining the differential palliative care needs of incarcerated patients in all communities.

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