Impacts of the carceral environment on autopsy-verified venous thromboembolism mortality

Abstract

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is a leading cause of mortality globally, with increasing incidence in the United States. However, no studies have examined VTE risk factors in carceral settings. This study evaluates VTE-related deaths in jailed and non-jailed populations in Los Angeles County over 16 years (2008–2023). Using death records, we compiled two datasets: one for deaths in Los Angeles County jails (n = 512) and another for deaths in the free population (n = 107,608). VTE cases were identified through keyword searches and reviewed for diagnostic consistency. Statistical analyses compared mortality rates and demographics, and a qualitative review of jailed VTE decedent autopsy records was conducted to identify risk factors linked to incarceration. VTE-related deaths in the jailed population were over three times higher than in the free population (3.5 % vs. 1.1 %, p = 0.0014). Crude mortality rates in jails have risen since 2014, peaking in 2021. Black individuals, while comprising 7.9 % of the county population and 29.4 % of the jail population, accounted for 66.67 % of VTE deaths in jails, highlighting exacerbated racial disparities. Structural and environmental factors in carceral settings, including restricted mobility, antipsychotic medication use, and restraints, likely contribute to elevated risks. Improving restraint use reporting and post-mortem toxicology findings for pulmonary embolism deaths can enhance etiology understanding. Diversion programs for mental health populations and other decarceral approaches, alongside anticoagulant prescriptions, could mitigate VTE risks and reduce health inequities in incarcerated populations.