Importance COVID-19 incidence and mortality are higher among incarcerated persons than in the general US population, but the extent to which prison crowding contributes to their COVID-19 risk is unknown. Objective To estimate the associations between prison crowding, community COVID-19 transmission, and prison incidence rates of COVID-19. Design, Setting, and Participants This was a longitudinal ecological study among all incarcerated persons in 14 Massachusetts state prisons between April 21, 2020, and January 11, 2021. Exposures The primary exposure of interest was prison crowding, measured by (1) the size of the incarcerated population as a percentage of the prison's design capacity and (2) the percentage of incarcerated persons housed in single-cell units. The analysis included the weekly COVID-19 incidence in the county where each prison is located as a covariate. Main Outcomes and Measures The primary outcome was the weekly COVID-19 incidence rate as determined by positive SARS-CoV-2 tests among incarcerated persons at each prison over discrete 1-week increments. Results There was on average 6876 people incarcerated in 14 prisons during the study period. The median level of crowding during the observation period ranged from 25% to 155% of design capacity. COVID-19 incidence was significantly higher in prisons where the incarcerated population was a larger percentage of the prison's design capacity (incidence rate ratio [IRR] per 10-percentage-point difference, 1.14; 95% CI, 1.03-1.27). COVID-19 incidence was lower in prisons where a higher proportion of incarcerated people were housed in single-cell units (IRR for each 10-percentage-point increase in single-cell units, 0.82; 95% CI, 0.73-0.93). COVID-19 transmission in the surrounding county was consistently associated with COVID-19 incidence in prisons (IRR [for each increase of 10 cases per 100 000 person-weeks in the community], 1.06; 95% CI, 1.05-1.08). Conclusions and Relevance This longitudinal ecological study found that within 14 Massachusetts state prisons, increased crowding was associated with increased incidence rates of COVID-19. Researchers and policy makers should explore strategies that reduce prison crowding, such as decarceration, as potential ways to mitigate COVID-19 morbidity and mortality among incarcerated persons.

中文翻译：

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2020 年 4 月至 2021 年 1 月马萨诸塞州监狱中监狱拥挤与 COVID-19 发病率之间的关联。

重要性 被监禁者的 COVID-19 发病率和死亡率高于美国一般人群，但监狱拥挤程度对其 COVID-19 风险的贡献程度尚不清楚。目的 估计监狱拥挤、社区 COVID-19 传播和监狱 COVID-19 发病率之间的关联。设计、设置和参与者这是一项纵向生态研究，研究对象为 2020 年 4 月 21 日至 2021 年 1 月 11 日期间在马萨诸塞州 14 所州立监狱中的所有被监禁者。被监禁人口占监狱设计容量的百分比以及 (2) 被关押在单间牢房中的被监禁人员的百分比。该分析包括作为协变量的每个监狱所在县的每周 COVID-19 发病率。主要结果和措施 主要结果是每周 COVID-19 发病率，该发病率由每个监狱的被监禁人员在不连续的 1 周增量中的 SARS-CoV-2 阳性检测确定。结果研究期间，14所监狱平均关押6876人。观察期间拥挤程度的中位数介于设计容量的 25% 到 155% 之间。在被监禁人口占监狱设计容量的比例较大的监狱中，COVID-19 的发病率明显更高（每 10 个百分点差异的发病率比 [IRR]，1.14；95% CI，1.03-1.27）。监狱中的 COVID-19 发病率较低，被监禁的人被安置在单牢房的比例较高（单牢房每增加 10 个百分点，IRR 为 0.82；95% CI，0.73-0.93）。周边县的 COVID-19 传播始终与监狱中的 COVID-19 发病率相关（IRR [社区中每 100 000 人周每增加 10 例病例]，1.06；95% CI，1.05-1.08）。结论和相关性 这项纵向生态研究发现，在马萨诸塞州的 14 所州立监狱中，拥挤程度的增加与 COVID-19 的发病率增加有关。研究人员和政策制定者应探索减少监狱拥挤的策略，例如监禁，作为降低被监禁人员 COVID-19 发病率和死亡率的潜在方法。