This study examines mortality in municipal and county detention and corrections facilities in a Midwestern county from 1988 to 2009. It is a follow-up to an earlier study that covered the previous 20 years (1968 - 1987) of inmate mortality, thus providing data for approximately four decades from which to identify those factors associated with inmate death, and how they may have changed over time. Although no single factor proved highly predictive of sudden death, certain variables and combinations of variables seemed more associated with in-custody death than others. Findings point toward the potential of improved intervention strategies for reductions in the mortality rate behind bars. (Published Abstract)