Abstract 03: Cardiovascular Disease Risk Factor Control Following Release From Carceral Facilities

Abstract

Background: Incarceration is a social determinant of cardiovascular disease (CVD) but is rarely addressed in clinical settings or cardiovascular prevention efforts. People who have been incarcerated are more likely to develop CVD at younger ages and have worse cardiovascular outcomes compared with the general population, even after controlling for traditional risk factors. The objective of this study is to identify incarceration-specific factors that are associated with uncontrolled CVD risk factors and identify potential targets for prevention specific to this population. Methods: Using data from Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE), a prospective cohort study of individuals released from incarceration with CVD risk factors, we examine the association between incarceration-specific and psychosocial factors and CVD risk factor control, including systolic blood pressure (SBP≥140 mmHg, diastolic blood pressure (DBP)≥90, body mass index (BMI)≥40, glycosylated hemoglobin (HbA1c) ≥8%, and low-density lipoprotein cholesterol (LDL-c) ≥160). Incarceration-specific factors include the conditions of confinement (jail vs. prison, time spent in solitary confinement), the carceral health care delivery system (co-payment, medication self-management, discharge planning), and collateral sanctions following release (barriers to housing, food, employment due to criminal record). Psychosocial factors included perceived discrimination and stress, self-efficacy, and lifetime adversity. Results: The mean age of participants (N=417) was 45.2 ±SD 10.7 years and disproportionately men (92%), racially minoritized groups (80%), and poor (66% without an income). Over half (53%) had at least one uncontrolled CVD risk factor. Having been incarcerated in a jail, as compared with prison, was associated with an increased odds of having an uncontrolled CVD risk factor, even after adjusting for age, race and ethnicity, gender, perceived stress, depression symptoms, and life adversity score (AOR 1.79, 95% CI 1.08-2.94). People held in jail, as compared with prison, had higher rates of smoking, uncontrolled hypertension, fewer opportunities to manage one’s own medications while incarcerated, or receive medications prior to release. Discussion: Release from jail is associated with worse CVD risk factor control and requires tailored intervention focused on smoking cessation, hypertension control, and improved discharge planning. These data are especially informative as states design and implement the Centers of Medicare & Medicaid Services new Medicaid Reentry Section 1115 Demonstration Opportunity, which allow Medicaid programs for the first time in history to cover services prior to release from correctional facilities that address chronic health conditions like cardiovascular disease and its risk factors.