COVID-19 Inequities By Sex Between US Carceral Facilities and General Population

Mimi Yen Li, BA and Shelby Grebbin
Department of Medicine
Division of Women’s Health
Poster Overview


The risk of COVID-19 among incarcerated people is much higher than the general population. Although data suggest that males have a higher risk of contracting COVID-19 than females in the general population, this has not been examined among incarcerated populations. It is uncertain whether incarceration may impact transmission rates differently between females and males. Our study aims to better understand the differences in COVID-19 infection rates, by sex, between incarcerated individuals and individuals in the general population within two states (Michigan and Maryland) that have enacted wide-spread testing. In addition, we compared rates of COVID-19 between incarcerated females and males. Between both states, rates of COVID- 19 infection by sex were 1.71 to 13.73 times higher among incarcerated individuals compared to individuals in the general state population. In Maryland, incarcerated females had a 1.78 times higher rate of infection than incarcerated males. There was no difference in infection rates between females and males in Michigan.

Scientific Abstract

Background and objective: Rates of COVID-19 in carceral settings significantly exceed that of the general population; however, differences by sex are uncertain. We compared sex-specific COVID-19 infection rates among incarcerated individuals and to the general population, using two states as case studies.

Methods: This population-based cross-sectional study included sex-specific Department of Corrections facilities in Maryland and Michigan, the only states with >85% COVID-19 testing rate and >5 cases within male and female facilities. Using publicly-available data from 9/1/2020, we calculated sex-specific cumulative case rates per 1,000 persons and the proportion of tested individuals. Comparisons by sex and to the general state populations were conducted with rate ratios (RR) and 95% confidence intervals (CI).

Results: Rates of COVID-19 were significantly higher among incarcerated females and males compared to each respective general state population, ranging from RR=1.71 (95%CI:1.56- 1.87) among males in Maryland to RR=13.74 (95%CI:13.34-14.14) among males in Michigan. Sex differences in infection rates among incarcerated females compared to males were observed only in Maryland (RR=1.78, 95% CI: 1.17-2.61).

Conclusions: Sex-specific infection rates in Michigan and Maryland’s carceral facilities are higher than rates in the general state population. Sex disparities within carceral systems may differ from those in the general population.

Clinical Implications
Better understanding the epidemiological differences of COVID-19 transmission by sex between the incarcerated and general population will inform mitigation strategies and resource allocation for groups that receive less testing and sustain greater risks of infection and death from COVID- 19.
Research Areas
Mimi Yen Li, Nicole Cassarino, Harika S. Dabbara, Jeannie V. Lee, Ankita Patil, Monik Carmen Jiménez, Shelby Grebbin
Principal Investigator
Monik Carmen Jiménez, Sc.D.

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