Health Care, Mortality, and Declining Occupancy Rates in California Prisons, 2013-2023.

Objectives. To assess relationships between changes in population levels, health care access, health care grievances, and mortality in California prisons. Methods. We examined 30 California prisons using June 2013 to May 2023 data from California Correctional Health Care Services and the California Department of Justice. Associations between prison occupancy rates and care access, health care grievances, and mortality were estimated in linear or generalized linear models controlling for staff vacancies and the characteristics of incarcerated people. Because of the prevalence of COVID-19-specific dynamics in prisons in 2020-2021, baseline models included data up to December 2019; data from January 2022 through May 2023 were added as a robustness check. Results. Reductions in prison occupancy rates were associated with increased access to care. Associations were more pronounced when postpandemic data were added. However, decreasing occupancy rates were not associated with declines in health care grievances or mortality. Conclusions. Lowering prison occupancy rates could help ensure better access to care, but it is not a panacea for alleviating varied health-related problems and dangers inside carceral facilities. (Am J Public Health. Published online ahead of print February 27, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308011).