title: Mortality of Youth Offenders Along a Continuum of Justice System Involvement.
abstract: BACKGROUND
  Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts.
  
  
  METHODS
  Criminal and death records of 49,479 youth offenders (ages 10-18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014.
  
  
  RESULTS
  From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality.
  
  
  CONCLUSIONS
  Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: maalsma@iu.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Aalsma
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Katherine S L
authors.initials: KSL
authors.lastname: Lau
authors.affiliation: Precision Statistical Consulting, LLC, Indianapolis, Indiana.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Katherine
authors.initials: K
authors.lastname: Schwartz
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Wiehe
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Patrick
authors.initials: P
authors.lastname: Monahan
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000208:ethnology; D002423:Cause of Death; D002648:Child; D003416:Criminal Law; D057237:Criminals / Q000706:statistics & numerical data*; D003644:Death Certificates; D005260:Female; D006708:Homicide / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana / Q000208:ethnology; D007604:Juvenile Delinquency / Q000639:trends*; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D044465:White People