Cardiovascular Disease Risk Factor Control Following Release from Carceral Facilities

BackgroundIncarceration is a social determinant of cardiovascular health but is rarely addressed in clinical settings or public health prevention efforts. People who have been incarcerated are more likely to develop cardiovascular disease (CVD) at younger ages and have worse cardiovascular outcomes compared with the general population, even after controlling for traditional risk factors. This study aims to identify incarceration-specific factors that are associated with uncontrolled CVD risk factors to identify potential targets for prevention. MethodsUsing 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 unique association between incarceration-specific 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 in solitary confinement), and collateral sanctions following release (barriers to housing, food, employment due to criminal record). Variables associated with uncontrolled CVD risk factors were included in the multivariate model to examine the unique contribution of each risk factor with uncontrolled CVD risk factors. ResultsParticipants (N=471), mean age of 45.0 {+/-}SD 10.8 years were disproportionately men (89%), from racially minoritized groups (79%), and poor (91% below the 100% federal poverty level). Over half (54%) had at least one uncontrolled CVD risk factor at baseline. People released from jail, compared with prison, had lower Lifes Essential 8 scores for blood pressure and smoking. Having been incarcerated in 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, and life adversity score (AOR 1.62, 95% CI 1.02-2.57). DiscussionRelease from jail is associated with poor CVD risk factor control and requires tailored intervention, which is informative as states design and implement the Centers of Medicare & Medicaid Services Reentry 1115 waiver, which allows Medicaid to cover services prior to release from correctional facilities.