The Long Arm of Incarceration: Incarceration History and Mortality Risk in a Nationally Representative Cohort of Older US Adults, 2012-2022.

Abstract

<b>Objectives.</b> To evaluate whether incarceration history is associated with mortality risk among older adults in the United States. <b>Methods.</b> We used data from the 2012/2014-2022 Health and Retirement Study, a nationally representative longitudinal panel of US adults aged 51 years and older. We estimated mortality risk using Gompertz proportional hazards models and calculated average marginal effects to estimate predicted years of life lost. Additional models examined results for men and age groups. We used matched analyses to assess robustness. <b>Results.</b> Incarceration history was associated with an 88% higher hazard of death (hazard ratio = 1.88; 95% confidence interval [CI] = 1.51, 2.35) after adjusting for sex, race/ethnicity, and childhood health and socioeconomic factors. Marginal predictions reveal individuals with previous incarceration were estimated to die 5.8 years earlier on average (95% CI = -8.26, -2.51), with stronger associations observed for men and adults younger than 75 years. <b>Conclusions.</b> Incarceration history is a durable determinant of premature mortality in later life. <b>Public Health Implications.</b> Accounting for incarceration exposure in aging and mortality research is critical for addressing structural drivers of health inequality in the United States. (<i>Am J Public Health</i>. 2026;116(8):1234-1243. https://doi.org/10.2105/AJPH.2026.308449).