Howell Benjamin A, Long Jessica B, Edelman E Jennifer, McGinnis Kathleen A, Rimland David, Fiellin David A, Justice Amy C, Wang Emily A
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.
Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
J Gen Intern Med. 2016 Dec;31(12):1496-1502. doi: 10.1007/s11606-016-3857-1. Epub 2016 Sep 12.
Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control.
Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we used logistic regression models adjusted for sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications.
Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated.
Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes.
监禁与高血压风险增加及心血管疾病死亡率升高相关。我们利用退伍军人老龄化队列研究（VACS）的数据来探讨监禁对血压（BP）控制的影响。
在患有高血压的VACS参与者中，我们测量了自我报告的近期监禁或过去（非近期）监禁史与调查后一年中血压控制之间的关联。为了分析监禁与血压控制之间的关联，我们使用了逻辑回归模型，并对社会人口学特征、临床因素（HIV状态和体重指数）以及行为因素（吸烟史、不健康饮酒、非法药物使用）进行了调整。我们探讨了潜在的中介因素，包括创伤后应激障碍（PTSD）、抑郁症、初级保健参与度以及抗高血压药物的依从性。
在3515名符合条件的VACS参与者中，2304名参与者符合纳入标准。其中，163名（7%）报告近期有过监禁，904名（39%）报告有过去的监禁史。有近期或过去监禁史的参与者比没有监禁史的参与者更有可能血压控制不佳（分别为67%、56%和51%，p < 0.001）。在多变量分析中，与从未被监禁的人相比，近期监禁（调整后的优势比[AOR] = 1.57，95%置信区间[CI]：1.09 - 2.26）与血压控制不佳相关，但过去的监禁史（AOR = 1.08，95% CI：0.90 - 1.30）则不然。
在有高血压病史的患者中，近期监禁与释放后血压控制不佳有关。需要对近期获释人员进行干预，以改善高血压治疗效果。
