Age-Standardized Mortality of Persons on Probation,in Jail,or in State Prison and the General Population,2001-2012

The findings of Wildeman et al ¹ about elevated mortality among persons in the criminal probation system are topical and compelling. We laud the authors’ use of innovative methods to address the dearth of research about persons on probation—the largest group in the criminal justice system yet the group about which the least is known.

In their discussion of potential mortality risks in this population, the authors note that individual conditions (eg, mental illness) and community conditions (eg, exposure to firearms) may increase the risk of mortality. Although we agree, we believe the discussion overlooks crucial social and structural factors that disproportionately affect persons on probation. Persons with criminal records are subject to discrimination in housing and employment. Furthermore, depending on local policies, they may be ineligible for certain social services. ² Although access to Medicaid among this population has improved with the Patient Protection and Affordable Care Act, many remain uninsured, and the process of reinstating suspended benefits after incarceration can be complex. ³ These social and structural issues work in tandem with those addressed by the authors to increase homelessness, poverty, lack of health care, and, ultimately, heightened mortality risk among persons in the criminal probation system.