People in the Los Angeles County Jail Are Staying Longer and Dying More, New Study Finds

More than 500 people died in the Los Angeles County Jail between 2008 and 2023. Over that time, mortality rates in the jails nearly doubled.

Much of that increase was driven by higher rates of suicides, overdoses, and other preventable causes of death, according to a new study published in the open-source journal PLOS One. 

Led by Professor Nick Shapiro and co-authored by several members of the UCLA Law Behind Bars Data Project team and the UCLA Carceral Ecologies Lab, the study is the first detailed analysis of who is dying in the LA County Jail —the largest jail system in the country—and why. Based on their review of more than 500 death certificates and 1.4 million bookings over a 15-year period, the authors found that people in the  Jail died are higher rates and longer into their stay than predicted by existing national data. 

Assembling the Data

Although a California law enacted in 2023 requires jails in the state to report deaths in custody on their websites, official data for earlier years offers limited details on the manner and cause of death, meaning that even if that data shows how many people died, it doesn’t shed substantial light on why they died.  

Existing data sources also lack crucial information about when and why someone entered jail in the first place and how long they stayed, leaving the public, policymakers, and researchers with a one-dimensional picture of individual deaths and little understanding of what factors are driving deaths in custody. 

To address these gaps, the study authors compiled a database of 509 deaths in the LA County Jail between 2008 and 2023, using records they obtained from the Los Angeles County Sheriff’s Department (LASD), the Los Angeles County Medical Examiner, the California Department of Justice, and the Los Angeles County Office of the Inspector General. These records allowed the authors to identify the first and last name, date of birth, race/ethnicity, sex, date of arrest, date of death, manner of death, place of death, detailed cause of death, and other critical information about each person who died during the 15-year period examined by the study. 

The authors also requested death certificate information using the Centers for Disease Control and Prevention (CDC)’s National Death Index (NDI). They used these records to verify information on decedents and obtain their underlying cause of death by ICD-10 code. In some cases, the authors also consulted cremation logs to verify demographic and date of death information for decedents.  

Shapiro at UCLA’s Carceral Ecologies Lab conceived this project approximately four years ago during his work with communities impacted by Los Angeles’s jail system.  Shapiro’s observations, as well as data collected by the Behind Bars Data Project during the pandemic, showed that mortality in the Jail had risen significantly and that this increase was not just due to COVID deaths. Deaths from overdoses and other causes reflecting worsening conditions also appeared to be growing. In interviews, family members of people who died in the Jail said that many deaths were occurring after extended durations in jail custody.  

Few recent studies have investigated this issue, so both teams began gathering records to make a detailed, comprehensive database of who died in the LA County Jail before, during, and after COVID—and why. The Carceral Ecologies Lab combined death records from each agency into a database containing close to 100 unique variables for each person who died. The authors also used data on more than 1 million bookings and arrests to reconstruct how the population of the Jail changed between 2008 and 2023 and to compare how people who died differed from the general Jail population.  

What They Found

Using standard ICD-10 codes from death certificates allowed the research team to conduct a detailed analysis comparing causes of death for people in the LA County Jail with the adult population of California as a whole. 

This analysis revealed that the Jail had significantly higher mortality rates from preventable causes of death such as suicides, overdoses, pulmonary embolisms, pneumonia, septicemia, gastro-intestinal bleeding, and heart disease when compared to California’s adult population.

The study documents a sharp increase in overall mortality in the LA County Jail, where the crude mortality rate nearly doubled between 2010 and 2022. Although the rate later declined from its pandemic peak, deaths remained far above pre-pandemic levels through the end of the study period in 2023, even as the number of deaths directly attributed to COVID-19 fell.  

Statistical modeling found that the increased mortality could not be explained by COVID-19 deaths alone. Even when the authors excluded COVID deaths from the sample,  mortality was significantly higher following the pandemic compared to pre-COVID years.  

The authors’ data suggests that the opioid crisis was responsible for much of the increase in mortality over the study period. Acute substance-related deaths accounted for just 4 percent of deaths in 2008 but nearly 34 percent in 2023. Reducing these deaths will require both preventing deadly substances from entering the Jail and expanding access to evidence-based treatment for substance use disorder, including medications for opioid use disorder.  

The study authors also suggest that increased mortality was partially driven by pandemic-era jail conditions, including longer confinement, reduced access to health care and substance-use treatment, staffing shortages, restricted visitation, increased isolation, and less out-of-cell time. These policies made incarceration harsher and more dangerous even as Los Angeles County reduced the number of people held in the Jail. 

The study also provided compelling new data about when people are at most at risk of dying in the LA County Jail. From 2008 through 2023, the median time from arrest to death in LA County was nearly two months. Just one in six deaths took place within one week of arrest. By contrast, a study by the federal Bureau of Justice Statistics had earlier found that most jail deaths nationwide occurred within 17 days of arrest; 40 percent happened within one week.  

Even more strikingly, the study found that most overdose deaths in LA County Jail occurred 63 days or more after arrest. This was an order of magnitude longer than national data from the Bureau of Justice Statistics, which found that the median time to death for overdoses in jail was less than 24 hours. This reveals that contraband drugs smuggled into the jail, not drugs consumed before arrest, were responsible for most drug-related fatalities in LA County Jail. 

Why This Study Is Unique

Most existing quantitative research on deaths in county jails offers only a bird’s-eye view, providing high-level figures based on national data that can obscure the unique factors at each jail that shape mortality risks and patterns. After all, the typical U.S. jail holds no more than a few hundred people at a time. By contrast, the LA County Jail incarcerates more than 13,000. 

Only a handful of other studies have carried out a similarly detailed analysis of deaths in large, urban jail systems. The most recent of these studies was published in 2007 and examined deaths in Chicago’s Cook County Jail between 1995 and 2004. Most other studies in this vein date back to the 1970s and 1980s. 

Conducting such a detailed analysis for more jails would require significant investments of time and money, as well as improvements to data collection infrastructure nationwide. Data collected by the federal government on jail deaths is incomplete, inaccurate, and out-of-date, meaning that researchers and policymakers who want to understand why people in jail are dying must seek out high-quality data themselves.  As the study authors noted in their paper: 

The data needed to conduct mortality studies in carceral facilities are becoming even more difficult to obtain. Even basic data, such as that reported prior to 2019 by the United States Department of Justice, are no longer being released publicly. Researchers therefore depend on a patchwork of state laws and the cooperation of corrections officials and medical examiners to obtain data through public records requests. Such data acquisition can be slow and involve redaction and discrepancies between sources. 

California has some of the strongest laws in the nation requiring transparency around deaths in custody. In states without requirements for investigating and reporting deaths, researchers, policymakers, and the public will remain in the dark about why people are dying in local jails and other carceral facilities. 

Why It Matters

The lack of detailed information about mortality in America’s largest jails is particularly concerning because these systems are massive—Los Angeles County jails holds nearly 13,000 people on any given day; Harris County (Houston, Texas) has an average daily jail population above 8,000; Cook County, Maricopa County (Phoenix, Arizona), Dallas County (Dallas, Texas), and New York City jails each hold more than 6,000 people; San Diego County and Miami-Dade County both have jail populations above 4,000. 

Jails also house people who are uniquely vulnerable. Nearly half of LA County’s jail population has a serious mental illness, making the jail system the nation’s largest mental healthcare provider. In 2022, lawyers for the U.S. Department of Justice excoriated the sheriff for his failure to manage a “mental health crisis” in the LA County Jail: 

Additionally, more than a quarter of the people jailed in LA County were homeless before their arrests, and an estimated two-thirds have substance use disorders. Yet most of these individuals are unable to access addiction treatment while incarcerated. Most people in jail are held pretrial, often for low-level misdemeanors or missed court dates. In Los Angeles, like many U.S. cities, jails often function as a social service provider of last resort; most people in jail aren’t dangerous—they need help. 

Filling the Gaps

Without high-quality data, it’s difficult or even impossible to answer basic questions about policy interventions that could help to reduce deaths: Does providing access to medication-assisted treatment (MAT) reduce overdose deaths? Which has better outcomes:  private or public correctional health providers? Does reducing or eliminating the use of solitary confinement help prevent suicides?  

In the current data environment, answering any of these questions would be a herculean task. A crucial first step, however, is gathering standardized data on the manner and cause of death for people who die in custody. 

That’s why BBDP has been using the National Death Index (NDI) to create a comprehensive repository of death certificates for people who die in U.S. carceral facilities. Experts on deaths in custody, like Dr. Roger Mitchell and Jay Aronson, have long called for a checkbox on death certificates to allow researchers, policymakers, and the public to understand the drivers of in-custody deaths. In the absence of this policy fix, NDI allows our project and other researchers to create our own standardized database of deaths to answer these questions. The Behind Bars Data Project has gathered thousands of these death certificates spanning jail and prison systems and expects to have over 20,000 death certificates by the end of 2026. This work is essential, but it is only a stopgap. Congress and state legislatures must enact new policies to ensure accurate and reliable reporting on deaths in custody at all levels so researchers and the general can learn why deaths are occurring and how to prevent them.