{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T18:00:19Z","timestamp":1785261619979,"version":"3.55.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["79111"],"award-info":[{"award-number":["79111"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","award":["22-07944"],"award-info":[{"award-number":["22-07944"]}],"id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Jail mortality in the United States has risen sharply in recent years, yet deaths in custody\u2014especially those related to substance use\u2014remain underexamined. The COVID-19 pandemic and the opioid crisis compounded pre-existing carceral health issues, necessitating a closer examination of their combined impact and aftermath. Previous reports suggest that incarcerated people\u2014particularly those who overdose on drugs\u2014die early in their confinement. This article indicates that the dual health threats of the COVID-19 pandemic and the opioid crisis have changed this relationship, substantially extending the time from arrest to death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate how duration of confinement, manners and causes of death (e.g., COVID-19, substance use), and pandemic mitigation policies impacted mortality in Los Angeles (LA) County Jail from 2008\u20132023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective, observational study utilizing linked datasets to identify mortality trends and associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>LA County Jail, the largest jail system in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We created three data sets: 1) LA County Jail deaths from 2008\u20132023, N\u2009=\u2009509, 2) City Jail\u00a0deaths within LA County, encompassing LA City Jail deaths 2008\u20132023, N\u2009=\u200942 and Non-LA City Jail\u00a0deaths, 2008\u20132023, N\u2009=\u200930, and 3) all bookings from 2010\u20132022, N\u2009=\u20091,435,479.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Main outcome(s) and Measure(s)<\/jats:title>\n                    <jats:p>Mortality trends over time, duration of incarceration prior to death, duration of incarceration for those released or transferred, and cause-specific mortality including direct standardized rates and standardized mortality ratios. Statistical models assessed the impact of confinement duration and pandemic and opioid crisis years on mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec007\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Jail mortality broadly, and substance-related deaths specifically, increased from 2008 to 2023, peaking during the pandemic. The median time from arrest to death was over five times as long (59 days) as the median duration of stay for all bookings (11 days). COVID-19 infection, prolonged confinement, and restrictive pandemic policies were associated with elevated mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec008\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Findings highlight the urgent need for reforms, including reduced incarceration; reduced incarceration duration; expanded access to substance use disorder treatment; decreased influx of drugs into jails; increased programming, visits, and out-of-cell time; and improved health safeguards.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351332","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:21:59Z","timestamp":1785259319000},"page":"e0351332","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Death by incarceration: Detention 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