Death in Delinquents: A 16-Year Prospective Study of Risk of Premature Mortality
Delinquent youth are at risk for early violent death after release from detention. Yet, few studies have examined risk factors for mortality. Prior investigations studied only serious offenders—a fraction of the juvenile justice population—and omitted females. The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanics, 1005 African Americans, 296 non-Hispanic whites, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors are drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates (death from any cause) and causes of death with the general population. We used survival analyses to examine risk factors for mortality after youth leave detention. Delinquent youth have higher mortality rates than the general population to age 29 years, irrespective of gender or race/ethnicity. Females died at nearly 5 times the general population rate. Hispanic males and females died at 5 and 9 times general population rates, respectively. Compared with the general population, significantly more delinquent youth died from homicide and its subcategory, homicide by firearm. Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites. Compared with non-Hispanic whites, African Americans had 4.5 times and Hispanics had 2.8 times the hazard of homicide. African American males had the highest mortality rates but among the lowest mortality ratios because death rates for this group in the general population are high. Our findings mirror racial/ethnic disparities observed in the general population: in 2010, African American males comprised 14.6% of the population aged 15-29 years, yet accounted for nearly 75% of deaths by homicide. Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later). Delinquent youth are an identifiable target population to reduce disparities in early violent death. Early prevention is key in reducing risk factors for mortality after youth leave detention.