The use of solitary confinement and in-custody mortality in North Carolina State Prisons, 2021-2023.

Purpose: Solitary confinement is associated with increased mortality post-release. Little is known about its use following recent reforms and COVID-19 challenges, and its association with in-custody deaths. We investigated patterns of and associations between solitary confinement and mortality in North Carolina (NC) state prisons. Methods: Using weekly housing data from Disability Rights NC, we created a retrospective cohort of those newly incarcerated in NC prisons between 2021 and 2023. We calculated the weekly proportion of individuals experiencing solitary confinement for 2+ weeks by type (e.g., administrative purposes). We calculated all-cause mortality rates stratified by those who did and did not experience solitary confinement. Results: Nearly one-quarter of 41,525 individuals in NC state prisons experienced solitary confinement. By the end of follow-up, over 6.0 % of individuals were in solitary confinement per week, and there were 43 in-custody deaths. Those who never experienced solitary confinement had an all-cause mortality rate of 1.96 per 100,000 person-weeks (95 % CI: 1.32, 2.82), and those who experienced solitary confinement had an all-cause mortality rate of 4.23 per 100,000 person-weeks (95 % CI: 2.31, 7.09). Conclusions: Solitary confinement is common in NC prisons and is associated with elevated death rates in custody. There is an urgent need to document the types and duration of solitary stays to ultimately end this punitive practice.