Abstract
BackgroundIncarceration has been associated with higher cardiovascular risk, yet data evaluating its association with cardiovascular disease events are limited. The study objective was to evaluate the association between incarceration and incident fatal and non-fatal cardiovascular disease (CVD) events.MethodsBlack and white adults from the community-based Coronary Artery Risk Development in Young Adult (CARDIA) study (baseline 1985–86, n = 5105) were followed through August 2017. Self-reported incarceration was measured at baseline (1985–1986) and Year 2 (1987–1988), and fatal and non-fatal cardiovascular disease events, including coronary heart disease, stroke, and heart failure, and all-cause mortality, were captured through 2017. Analyses were completed in September 2019. Cumulative CVD incidence rates and Cox proportional hazards were compared overall by incarceration status. An interaction between incarceration and race was identified, so results were also analyzed by sex-race groups.Results351 (6.9%) CARDIA participants reported a history of incarceration. Over 29.0 years mean follow-up, CVD incidence rate was 3.52 per 1000 person-years in participants with a history of incarceration versus 2.12 per 1000 person-years in participants without a history of incarceration (adjusted HR = 1.33 [95% CI, 0.90–1.95]). Among white men, incarceration was associated with higher risk of incident cardiovascular disease (adjusted HR = 3.35 [95% CI, 1.54–7.29) and all-cause mortality (adjusted HR = 2.52 [95% CI, 1.32–4.83]), but these associations were not statistically significant among other sex-race groups after adjustment.ConclusionsIncarceration was associated with incident cardiovascular disease rates, but associations were only significant in one sex-race group after multivariable adjustment.
Highlights
Incarceration has been associated with higher cardiovascular risk, yet data evaluating its association with cardiovascular disease events are limited
Longitudinal community-based cohort studies have demonstrated an association between incarceration and risk factors for cardiovascular disease (CVD), including incident hypertension, as well as corresponding cardiac structural changes [5]
Mechanisms relating incarceration to CVD have been proposed by a National Heart, Lung, and Blood Institute workshop committee, including socio-demographic factors associated with disproportionate CVD risk, stress and mental health associated with incarceration, potentially unhealthy behaviors and limited health care during incarceration leading to increased burden of CVD risk factors, and poorer health care access following release [3]
Summary
Incarceration has been associated with higher cardiovascular risk, yet data evaluating its association with cardiovascular disease events are limited. The study objective was to evaluate the association between incarceration and incident fatal and non-fatal cardiovascular disease (CVD) events. Cardiovascular disease (CVD) is the leading cause of death among the estimated 2.2 million individuals who are incarcerated in the United States [3]. Longitudinal community-based cohort studies have demonstrated an association between incarceration and risk factors for CVD, including incident hypertension, as well as corresponding cardiac structural changes [5]. To our knowledge, longitudinal, community-based cohort data exploring the relationship between incarceration and incident CVD events have not been published. The objective of this analysis was to evaluate the long-term association between adult incarceration history and incident fatal and non-fatal CVD events among white and Black participants in the Coronary Artery Risk Development in Young Adults community-based cohort study
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