With the highest incarceration rate in the world, the inability to provide adequate health care and facilities in United States prisons is paramount, especially given unequal incarceration rates by race. This study analyzes 1998 and 1999 National Prisoner Statistics from the U.S. Department of Justice. Using the context of federal funding incentives and truth-in-sentencing laws, which drastically increased sentence lengths and overcrowding, this study explores the relationship between overcrowding and unnatural deaths among incarcerated populations at the state-level. The inability of United States prisons to address health and safety needs and the overwhelming lack of reporting and preventable deaths among state and federal-level prisons is cause for concern about the operations of these facilities. With COVID-19 posing new challenges to disease prevention and safety, the impacts of overcrowding, and its links to negligent death in prisons, this topic is as relevant an issue today as it was twenty years ago.