Abstract
BackgroundPeople who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population. Despite this, little is known regarding what pathways mediate the association between incarceration exposure and increased rates of CVD morbidity and especially what incarceration specific factors are associated with this risk. The objective of this study is to better understand CVD risk in people exposed to incarceration and the pathways by which accumulate cardiovascular risk over time.Methods and AnalysisThe Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study is a prospective cohort study of individuals released from incarceration with known cardiovascular risk factors. We are recruiting 500 individuals within three months after release from jail/prison. At baseline we are assessing traditional risk factors for CVD, including diet, exercise, and smoking, and exposure to incarceration-related policies, psychosocial stress, and self-efficacy. Cardiovascular risk factors are measured at baseline through point of care testing. We are following these individuals for the 12 months following the index release from incarceration with re-evaluation of psychosocial factors and clinical risk factors every 6 months. Using these data, we will estimate the direct and indirect latent effects of incarceration on cardiovascular risk factors and the paths via which these effects are mediated. We will also model the anticipated 10-year burden of CVD incidence, health care use, and mortality associated with incarceration.DiscussionOur study will identify factors associated with CVD risk factor control among people released from incarceration. Our measurement of incarceration-related exposures, psychosocial factors, and clinical measures of cardiovascular risk will allow for identification of unique targets for intervention to modify CVD risk in this vulnerable population.
Highlights
People who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population
Studies have repeatedly shown that exposure to incarceration, ranging from being incarcerated [8,9,10], to having a family member incarcerated [11], and even living in a neighborhood with high rates of incarceration is associated with worse CVD outcomes
Study objectives The primary objective of this study is to examine the association between population-specific risk factors and clinical evidence of control of CVD risk factors such as hypertension, hyperlipidemia, diabetes, and obesity
Summary
People who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population. The presence of CVD or related risk factors, such as smoking and hypertension, is influenced by racialized social structures and policies, which affect most facets of life, including education, income, homeownership, employment, and access to healthcare [2]. One such structural underexplored determinant of the development and progression of CVD is incarceration. The factors (Fig. 1) that elevate CVD risk in this population are largely unknown and are only partly driven by a higher prevalence of conditions and risk factors associated with heart disease such as smoking [15, 16], diabetes, hypertension, and obesity [17, 18]
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