TY - JOUR

T1 - The Effects of the COVID-19 Pandemic on People Experiencing Incarceration: a Systematic Review

AU - Williams, D.B.

AU - Spinks, Bethany

AU - Williams, Denitza

AU - Lewis, Ruth

AU - Bull, Francesca

AU - Edwards, Adrian

PY - 2024/4/5

Y1 - 2024/4/5

N2 - Objective To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with thegeneral population.Design Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination’s good practice guidelines.Data sources Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19Evidence databases were searched up to 21 October 2022.Eligibility criteria for selecting studies We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studiesfocussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded.Data extraction and synthesis Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation,mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available.Results 4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA andwere retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2infection and poorer clinical outcomes.Conflicting data were found regarding vaccine uptake andtesting rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI.Conclusion PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-qualityresearch of continuing clinical outcomes and appropriate mitigatinginterventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources forthis vulnerable group should be a focus of national policy in the event of future pandemics.PROSPERO registration number CRD42022296968.

AB - Objective To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with thegeneral population.Design Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination’s good practice guidelines.Data sources Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19Evidence databases were searched up to 21 October 2022.Eligibility criteria for selecting studies We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studiesfocussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded.Data extraction and synthesis Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation,mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available.Results 4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA andwere retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2infection and poorer clinical outcomes.Conflicting data were found regarding vaccine uptake andtesting rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI.Conclusion PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-qualityresearch of continuing clinical outcomes and appropriate mitigatinginterventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources forthis vulnerable group should be a focus of national policy in the event of future pandemics.PROSPERO registration number CRD42022296968.

U2 - 10.1136/ bmjopen-2023-076451

DO - 10.1136/ bmjopen-2023-076451

M3 - Article

VL - 14

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

M1 - e076451

ER -