Mortality trends from 2016 to 2023 among adults who have experienced incarceration across five provincial correctional programs

The number of people supervised in correctional facilities each year is driven by complex social determinants related to crime and offending and at different stages of the criminal justice process, including police charging practices, court case processing, and sentencing decisions.

Although the police-reported crime rate in Canada has increased over the past decade, the total number of cases in adult criminal courts and the overall incarceration rate have both declined (Lappi-Seppälä, 2025; Statistics Canada, 2025a; Statistics Canada, 2025b). Some of the decreases in the overall incarceration rate can be explained by efforts to reduce the number of people in custody during the beginning of the COVID-19 pandemic (Johnson & Leclerc, 2024; Owusu-Bempah et al., 2025; Ricciardelli et al., 2021). For example, from 2015/2016 to 2020/2021 the incarceration rate for provincial and territorial correctional facilities in Canada declined (from 88 to 62 per 100,000 adults), and has subsequently risen, reaching 78 per 100,000 adults in 2023/2024 (Statistics Canada, 2025c). Overall, the trend towards lower incarceration rates began before the pandemic and, in some provinces and territories, has persisted (Public Safety Canada, 2026; Statistics Canada, 2025c).

There has been a marked increase in the number of drug toxicity deaths^Note  in Canada since 2015 (Dasari et al., 2025; Statistics Canada, 2025d), and research shows that a large number of these deaths occur among people involved with correctional services (Borschmann et al., 2024; Butler et al., 2023; Fischer et al., 2024; Slaunwhite et al., 2026). Many social determinants of health that are associated with substance use, such as poverty, housing instability, discrimination, and adverse childhood experiences, are also associated with involvement in the criminal justice system (Caruso, 2017; Rotter & Compton, 2022). Substance use occurs before all accidental drug toxicity deaths, and being under the influence of, or seeking, drugs may contribute to the perpetration of violent and non-violent crimes (Young et al., 2021). Changes in access to drugs while in custody can affect a person’s drug tolerance or the amount needed for toxic effects to be fatal, increasing the risk of overdose upon release (Joudrey et al., 2019). Research shows that the risk of overdose is especially high in the days and weeks immediately after release from custody (Keen et al., 2020; Kinner et al., 2021; Kouyoumdjian et al., 2016a; Merrall et al., 2010).  

In addition to drug-related deaths, people with a history of involvement in correctional services are at elevated risk for other causes of death. Elevated rates of suicide, homicide, injuries, and chronic disease have been found to contribute to premature mortality in this population (Skinner & Farrington, 2020; Welsh et al., 2022). Some research suggests that there are gender specific effects of incarceration on premature mortality, such that health and other socio-demographic factors do not fully account for the relationship between incarceration and mortality among women (Massoglia et al., 2014). Lower life expectancy and higher premature mortality have also been observed among population groups that are overrepresented in correctional services, such as Indigenous and Black population groups (Park, 2021; Robinson et al., 2023; Statistics Canada, 2026a; Tjepkema et al., 2023).^Note 

This Juristat article examines annual mortality rates within a population of individuals who have been incarcerated, exploring changes over time and comparisons with the general population. The article describes all-cause^Note  and cause-specific^Note  mortality trends for incarcerated adults relative to the trends observed in the rest of the Canadian population.^Note   

Section 1: Study cohort

The cohort for this study was drawn from data on custodial involvement within adult provincial correctional facilities in the five jurisdictions consistently reporting to the Canadian Correctional Services Survey (CCSS): Nova Scotia, Ontario, Saskatchewan, Alberta, and British Columbia. These data were linked to mortality records from the Canadian Vital Statistics Death Database (CVSD) and the Canadian Coroner and Medical Examiner Database (CCMED).^Note  For more information, see Data Sources and Methodology.

For each year from 2016 to 2023, the individuals who stayed in a correctional centre for at least one night in that calendar year or the previous calendar year were selected for inclusion in the “incarcerated” population. A second eligibility criterion was applied to ensure that the individual had not already died before the start of the year in which deaths were counted. Any incarcerated individual who had died before January 1 was excluded from the incarcerated population for that reference year.

In total, there were 280,516 unique individuals who were eligible for inclusion in the cohort for this study between 2016 and 2023. Most (47%) of these people had just one custody stay during the study period. Some individuals were part of the cohort for several calendar years: 26% were part of the incarcerated population for 3 or 4 calendar years and 21% contributed to the incarcerated population in 5 or more calendar years. This is consistent with the fact that about half of people released from provincial custody are reconvicted within a year and 70% are reconvicted within five-years (Pedneault et al., 2024; Statistics Canada, 2026b).

Within the provincial and territorial correctional system, lengths of stay in custody are generally shorter, as these systems supervise individuals serving custodial sentences of less than two years, while those sentenced to two years or more are supervised within the federal correctional system. Between 2016 and 2023, both the average (between 89 to 100 days) and median (between 41 and 50 days) lengths of stay in custody remained relatively stable.

The size of the incarcerated population has changed over time

The size of the incarcerated population varied year to year, ranging from a high of 129,230 adults in 2017 to a low of 88,225 adults in 2022 (Table 1). Despite decreasing in size, the demographic composition of this population remained relatively stable from 2016 to 2023 (Table 2). Around 85% of the cohort each year were men and the median age each year ranged from 33 to 35. Over 70% of the cohort in each year were between the ages of 20 and 49 years old. This has an important impact on comparisons with the non-incarcerated population, where approximately half of the population is male and less than half are between 20 and 49 years old.

The number of incarcerated adults declined from 2016 to 2023 in all five of the provinces in the cohort, except Saskatchewan (Chart 1, Table 3, Table 4). The largest changes in the number of incarcerated adults were observed in British Columbia (-32%) and Alberta (-36%).

Chart 1 start

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Section 2: All-cause mortality among adults who have experienced incarceration

There was a total of 13,525 deaths observed among incarcerated adults in this study, with the annual total increasing from 1,155 deaths in 2016 to 2,215 deaths in 2023 (Table 1). Since the total number of deaths almost doubled while the size of the incarcerated population declined during the same period, the overall mortality rate was substantially higher going from 94 deaths per 10,000 incarcerated adults in 2016 to 230 deaths per 10,000 in 2023 (+145%).

Almost all (96%) deaths in the incarcerated population occurred in the community after release from custody, while approximately 4% of deaths among individuals who experienced incarceration occurred while they were under custodial supervision. However, the majority of this latter group of deaths (62%) occurred while the person was not in custody (for example, when the person supervised was unlawfully at large, on conditional release or while serving the community portion of an intermittent sentence). Among individuals who died following release from custody, the average (156 days) and median (198 days) time from release to death was consistent across the study period. However, because this analysis focused on people who were incarcerated in the reference year or the year before, the maximum time that could have elapsed between custody and death was 2 years. There are deaths that occurred more than 2 years after release from custody that were not captured in this analysis.

Mortality rates among adults who have experienced incarceration vary by province

The mortality rates among incarcerated adults were higher in some provinces relative to others (Table 3, Table 4).^Note  That said, the trend of increasing mortality rates from 2016 to 2023 within the incarcerated population was observed in all five provinces.^Note  Mortality rates doubled from 2016 to 2023 among adults who had been incarcerated in British Columbia, Ontario, Saskatchewan, and Nova Scotia, while they were more than three times higher in Alberta. In 2016, adults who had been incarcerated in British Columbia had the highest mortality rate (149 deaths per 10,000 adults) relative to the other provinces in the cohort, followed by Alberta (107 deaths per 10,000 adults). By 2023, mortality rates for incarcerated adults had risen to 365 deaths per 10,000 in Alberta, and 334 deaths per 10,000 in British Columbia.

Because of the high prevalence of drug toxicity deaths in the incarcerated population (see section 3: Cause-specific mortality among adults who have experienced incarceration), the mortality trends across provinces may reflect, in part, differences in the impact of the toxic drug crisis at different times in different provinces (Dasari et al., 2025; Fischer et al., 2025).  

Mortality rates for incarcerated women were similar or higher than the mortality rates observed among incarcerated men in the same age group

Mortality rates in the Canadian population differ a lot based on age and sex. As noted in Section 1, the recently incarcerated population is much younger and includes a much larger proportion of men compared to the general population. Mortality rates were estimated separately for men and women in specific age groups in order to facilitate comparisons between the incarcerated population and the rest of the Canadian population.

When mortality rates among adults who had been incarcerated were disaggregated by age group and estimated separately for men and women (Table 5; Table 6; Table 7; Table 8; Table 9; Table 10), the results showed all-cause mortality rates were highest in older age groups for both men and women. Although there was some variation from year to year, mortality rates were generally the same or higher for women who had been incarcerated compared to men in the same age group who had been incarcerated (Chart 2). This sex difference is very different from the pattern in the general population. Men in Canada in their 20s, 30s, and 40s generally have mortality rates that are significantly higher than the mortality rates of women (Statistics Canada, 2026c).

Chart 2 start

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Mortality rates have risen more sharply among the incarcerated population compared to the rest of the Canadian population

Mortality rates have increased in general between 2016 and 2023, but they rise more sharply among incarcerated adults compared to the rest of the Canadian population. In 2016, the all-cause mortality rate was nine times higher for men in their 20s who had been incarcerated (67 deaths per 10,000 adults) compared to men who had not been incarcerated (7 per 10,000) (Table 5). By 2023, the gap was twice as wide; there were 18 times more deaths per 10,000 adults among men aged 20 to 29 (145 per 10,000) who had been incarcerated relative to those who were not (8 per 10,000). Relative to 2016, the mortality rate in 2023 was 116% higher among men aged 20 to 29 who had been incarcerated, while it was 8% higher among the non-incarcerated men.

Similar trends were observed for men aged 30 to 39 (Table 6 and Chart 3). Although the difference in mortality rates for incarcerated men in their 40s relative to the non-incarcerated men was not as large, they showed a similar trend over time, going from a six-fold difference in 2016 to a 12-fold difference in 2023 (Table 7 and Chart 3).

From 2016 to 2023, there were about twice as many deaths among men aged 20 to 49 as there were among women in the same age group (Statistics Canada, 2026d), such that young adult women in Canada have lower mortality rates than young adult men. However, this was not the case within the incarcerated population, where mortality rates were usually higher among women. As a result, there were even larger disparities observed for mortality rates among women who had experienced incarceration. Deaths per 10,000 adults were 9 to 47 times higher among women who had been incarcerated relative to women of the same age in the rest of the Canadian population (Table 8; Table 9; Table 10), with the gaps widening substantially from 2016 to 2023 (Chart 3).

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Section 3: Cause-specific mortality among adults who have experienced incarceration

The leading causes of death in Canada have changed over time and vary considerably based on age. In 2023, the large majority (80%) of all deaths in Canada occurred among people aged 65 years and older, with cancer and heart disease being the leading causes of death (Statistics Canada, 2026c; Statistics Canada, 2026d). However, given that most (85%) of the incarcerated population in this study is under the age of 50, it is important to consider what the leading causes of death are for people aged 20 to 49 rather than for all Canadians. In this age range, relative to older adults, deaths from natural causes are less common and the leading causes of death include external causes of deaths such as accidental injuries, suicide, and homicide (Ray, 2017; Statistics Canada, 2026c).

Accidental drug toxicity deaths were a major contributor to the rise in all-cause mortality among adults who experienced incarceration

Accidental drug toxicity was consistently the most common underlying cause of death for adults who experienced incarceration (Table 11; Table 12). The percentage of deaths among adults who had been incarcerated that were attributed to accidental drug toxicity ranged from as low as 40% in 2016 to 61% in 2021. Added together, deaths attributed to accidental drug toxicity and ill-defined or unspecified causes^Note  account for a growing proportion of all deaths among adults who have experienced incarceration (Chart 4).

Because it can take several years for a death investigation to be completed and for the underlying cause of death to be determined, some deaths that are currently attributed to an unknown or unspecified cause may eventually be attributed to accidental drug toxicity (or some other cause of death). Although accidental drug toxicity deaths currently account for 60% and 54% of deaths among incarcerated adults in 2022 and 2023, respectively, there are still many deaths in which the final underlying cause has not been determined.^Note    As a result, it is possible that the percentage of deaths among incarcerated adults due to accidental drug toxicity in 2022 and 2023 may ultimately exceed the percentage observed in 2020 or 2021.

Chart 4 start

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The number of deaths attributed to accidental drug toxicity has increased in recent years, and this increase in accidental drug toxicity mortality has occurred to a greater extent among those who have been incarcerated. Among men aged 20 to 49, there were 41 accidental drug toxicity deaths per 10,000 incarcerated men in 2016 compared to 2 deaths per 10,000 similarly aged men who had not been incarcerated (Table 13). By 2021, the accidental drug toxicity mortality rate among incarcerated men aged 20 to 49 had increased to 147 per 10,000, almost 40 times higher than the mortality rate for men in the same age group who had not been incarcerated (3.8 per 10,000).

The difference in accidental drug toxicity mortality based on incarceration was even more pronounced among women (Table 14). In 2016, the number of deaths attributed to accidental drug toxicity per 10,000 population was more than 50 times higher among women aged 20 to 49 who had been incarcerated (36 per 10,000) relative to all other women in the same age group who had not been incarcerated (0.6 per 10,000). By 2021, the rate of deaths from accidental drug toxicity was over 100 times higher among women who had experienced incarceration (173 per 10,000) than among women of the same age in the rest of the Canadian population (1.7 per 10,000).

Men aged 20 to 49 who had experienced incarceration had suicide mortality rates that were 5 to 8 times higher than the rate for other men in the same age group

Suicide mortality among adults who had been incarcerated remained relatively stable throughout the study period, ranging from as low as 12 to as high as 15 deaths per 10,000 adults, depending on the year (Table 12).^Note  Although population health data shows that suicidal thoughts and behaviours are more prevalent among young women, suicide mortality is higher among young men (Public Health Agency of Canada, 2025). Suicide is the second leading cause of death for men in their 20s and 30s (Statistics Canada, 2026c). Men aged 20 to 49 who had experienced incarceration had suicide mortality rates that ranged from 5 to 8 times higher each year, relative to men in the same age group who had not been incarcerated (Table 15). In 2023, there were 13 deaths by suicide for every 10,000 incarcerated men, compared with 1.9 per 10,000 men who were not incarcerated.

Suicide mortality trends among incarcerated women are not presented due to the small size of the population of incarcerated women and the number of suicide deaths within this population each year.

Homicide mortality was about 30 times higher among men aged 20 to 49 who had experienced incarceration relative to other similarly aged men

Although relatively rare, homicide consistently ranks among the top 25 leading causes of death in Canada, with about 500 deaths attributed to homicide each year, according to national mortality data (Statistics Canada, 2026c).^Note  People with a history of involvement in criminal activities are more likely to be victims of crime, including homicide (Jennings et al., 2012). Therefore, although some other causes of mortality (e.g. accidental injuries or suicide) were more common among recently incarcerated adults, homicide showed one of the greatest disparities with those who had not been incarcerated. The annual mortality rate for homicide deaths among men aged 20 to 49 who had experienced incarceration ranged between 5 and 9 homicide deaths per 10,000.^Note  This was consistently about 30 times higher than the mortality rate for men in the same age group who had not been incarcerated (Table 16).

Homicide mortality trends among incarcerated women are not presented due to the small size of the population of incarcerated women and the number of homicide deaths within this population each year.

Conclusion and future directions

This article shows that adults who have been incarcerated have higher mortality rates compared to the rest of the Canadian population and that the number and rate of deaths in the incarcerated population has risen substantially from 2016 to 2023. The most common causes of deaths were unnatural causes such as accidental drug toxicity, suicide, homicide, and other accidents—deaths which can be prevented with targeted public health interventions, early identification of risk factors, and improved access to healthcare and social supports. Accidental drug toxicity mortality was by far the most common cause of death among adults who had experienced incarceration and was largely responsible for the increases in death rates among this population. Although accidental drug toxicity deaths also increased in the general population, the mortality rate from accidental drug toxicity was almost 40 times higher among incarcerated men and around 100 times higher among incarcerated women aged 20 to 49 relative to the non-incarcerated men and women, respectively.

Public health and safety efforts to address these causes of death often start upstream such that contact with correctional services itself is also prevented (Gourevitch et al., 2022). Supporting individuals released from custody includes preventing recidivism, as well as supporting good health and preventing death. Some interventions to reduce harms related to substance use among people who have experienced incarceration effect a range of health, social, and justice system outcomes (Macdonald et al., 2024).

In this study, the maximum length of time between time in custody and a death was two years. This means that the analysis focused on causes of death that occur close to a release from custody. Future research could use a longer look-back period to capture causes of death related to chronic disease, which may take longer to develop. It may also be worth exploring how health status can influence who belongs to the incarcerated population and the impact this has on observed mortality trends. Individuals with severe health conditions (e.g., diagnosis of a terminal illness) may follow different pathways through the criminal justice system, as medical circumstances can be considered at various stages, including sentencing decisions and, in some cases, decisions regarding continued custody (Criminal Code, RSC 1985, c C-46; Kouyoumdjian et al., 2016b).

Given the large number of deaths attributed to accidental drug toxicity in the incarcerated population, it will be important to continue monitoring mortality trends in this population as Canada’s drug toxicity crisis continues to evolve, and the number of correctional programs reporting to the CCSS increase. Recent surveillance data suggest that the number of opioid-related deaths in Canada started to decline in 2024 and 2025 (Substance-related Overdose and Mortality Surveillance Task Group, 2026). Future research could examine how correctional involvement contributes to mortality outcomes among population groups that are overrepresented in correctional services, including Indigenous and Black populations. Given persistent disparities in correctional involvement among these populations, efforts to address overrepresentation may have implications for future mortality trends (Robinson et al., 2023).

Detailed data tables

Table 1 Deaths among adults who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 2 Age and sex distribution of the incarcerated population, 2016 to 2023

Table 3 Deaths among adults who experienced incarceration in Nova Scotia, Ontario, and Saskatchewan 2016 to 2023

Table 4 Deaths among adults who experienced incarceration in Alberta and British Columbia, 2016 to 2023

Table 5 Deaths among men aged 20 to 29 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 6 Deaths among men aged 30 to 39 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 7 Deaths among men aged 40 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 8 Deaths among women aged 20 to 29 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 9 Deaths among women aged 30 to 39 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 10 Deaths among women aged 40 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 11 Number of deaths among adults who experienced incarceration across five provincial correctional programs, by select grouped causes, 2016 to 2023

Table 12 Mortality rate among adults who experienced incarceration across five provincial correctional programs, by select grouped causes, 2016 to 2023

Table 13 Accidental drug toxicity deaths among men aged 20 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 14 Accidental drug toxicity deaths among women aged 20 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 15 Suicide deaths among men aged 20 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Table 16 Homicide deaths among men aged 20 to 49 who experienced incarceration across five provincial correctional programs, 2016 to 2023

Data Sources and Methodology

Canadian Correctional Services Survey

The Canadian Correctional Services Survey (CCSS) is an administrative survey conducted by the Canadian Centre for Justice and Community Safety Statistics (CCJCSS) that collects data from correctional services across Canada, including characteristics of people being supervised and their legal hold statuses. As of 2015/2016, CCSS data included correctional service program data from British Columbia, Alberta, Saskatchewan, Ontario (adult data only), Nova Scotia and Newfoundland and Labrador (youth data only). CCSS data collection was expanded in subsequent years, and now includes data from Prince Edward Island, Correctional Services Canada, and youth corrections data from Ontario. This report only includes data from adult correctional supervision programs available since 2015/2016 and thus only covers adults who have been involved with correctional services in Nova Scotia, Ontario, Saskatchewan, Alberta, and British Columbia in the definition of the incarcerated population.

Canadian Vital Statistics – Death database

The Canadian Vital Statistics – Death database (CVSD) is an administrative survey that collects information from all provincial and territorial vital statistics registries on all deaths in Canada. Each death record contains information on the underlying cause of death, which is defined by the World Health Organization as the disease or injury that initiated the chain of events leading directly to death, or as the circumstances of the accident or violence that produced the fatal injury. The underlying cause of death is selected from the causes and conditions listed on the medical certificate of cause of death, which is completed by a medical professional, medical examiner or coroner.

Causes of deaths were grouped into categories based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, (ICD-10) classification for the underlying cause of death. The following categories were chosen to reflect the most common causes of death among people involved in correctional services.

• Accidental drug toxicity (X40-X44)
• Other accidental deaths, excluding drug toxicity (V01-X39, X45-X59)
• Suicide (X60-X84, Y87.0)
• Homicide (X85-Y09, Y87.1)
• Substance use disorders (F10-F19)
• Cancer (C00-C97)
• Diseases of the circulatory system (I00-I99)
• Ill-defined and unknown causes (R99)
• All other specified causes

Canadian Coroner and Medical Examiner Database

The Canadian Coroner and Medical Examiner Database (CCMED) combines information from 12 provincial and territorial databases (excluding Manitoba) to provide national level information on the circumstances related to deaths reported to and investigated by coroners and medical examiners. The CCMED can have information on the cause of death for deaths that required an investigation before this information is available in the CVSD. Some of the deaths with an ill-defined and unknown underlying cause in the CVSD were re-categorized as accidental drug toxicity, other accidents, or suicides based on the manner and cause of death recorded in the CCMED. Generative artificial intelligence (GPT-4o mini) was used to identify drug toxicity deaths based on text data captured in the CCMED's cause of death fields. Manual review was conducted to verify the accuracy of the classification.

Linkage

The CCSS was linked to the CVSD and the CCMED through the Social Data Linkage Environment (SDLE), a highly secure environment that facilitates the creation of linked population data files for social analysis. Specifically, each file is linked to a secure repository of personal identifiers in the SDLE, after which each person is assigned a unique, anonymous key that allows their data to be integrated with other files within the SDLE. Over 97% of individuals in the CCSS who experienced custody from April 1, 2015, to December 31, 2023, could be linked to this secure repository and were eligible for linkage to the CVSD and CCMED.

Definition for identifying incarcerated people

The CCSS data is collected based on the fiscal year (April to March), whereas Canadian mortality statistics are reported annually based on the calendar year (January to December). In this report, the population at risk is defined for a calendar year to be consistent with other reports of mortality rates for the total population of Canada (e.g., Statistics Canada, 2025d; Statistics Canada, 2026d).

A population of incarcerated individuals who were at risk of dying from any cause of death was defined for each calendar year from 2016 to 2023. The following eligibility criteria were used:

• Individuals with at least one event in custody within the 2-year period ending on December 31 of the reference year
• Individuals without any death recorded in the CVSD before January 1 of the reference year.

Using this approach means that individuals could have been in custody at the time of their death or could have been in custody up to 2 years before their death occurred. The type of sentence or length of time in custody is not taken into consideration. As a result, the mortality rates in this study may differ from what is reported in other studies that focus on mortality risk immediately after release from custody or that consider the length of time between release from custody and death.

The definition of incarcerated individuals was limited to incarcerations within adult provincial correctional services in British Columbia, Alberta, Saskatchewan, Ontario, and Nova Scotia. Events in custody within youth services, provincial services in other jurisdictions, or federal correctional services are not included. The majority of custodial admissions each year are to provincial correctional services,^Note  and these 5 provinces account for about two thirds of the population in adult provincial and territorial correctional services (Statistics Canada, 2025c).

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