Howell Benjamin A, Puglisi Lisa B, Aminawung Jenerius, Domingo Kirsten Bibbins-, Elumn Johanna, Gallagher Colleen, Horton Nadine, Kazi Dhruv S, Krumholz Harlan M, Lin Hsiu-Ju, Roy Brita, Wang Emily A
SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA.
Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
BMC Public Health. 2022 Feb 16;22(1):331. doi: 10.1186/s12889-022-12688-x.
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. 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.
The 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.
Our 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.
曾被监禁的人群中，心血管危险因素（如高血压和吸烟）的发生率较高，心血管疾病（CVD）是该人群住院和死亡的主要原因。尽管如此，对于何种途径介导监禁暴露与CVD发病率增加之间的关联，尤其是哪些特定的监禁因素与这种风险相关，人们知之甚少。本研究的目的是更好地了解曾被监禁人群的CVD风险，以及随着时间推移累积心血管风险的途径。
“涉及司法人员心血管疾病流行病学研究（JUSTICE）”是一项针对有已知心血管危险因素且已从监禁中获释人员的前瞻性队列研究。我们正在监狱/看守所释放后的三个月内招募500名个体。在基线时，我们将评估CVD的传统危险因素，包括饮食、运动和吸烟，以及与监禁相关政策的暴露情况、心理社会压力和自我效能感。通过即时检验在基线时测量心血管危险因素。我们将对这些个体在首次从监禁中获释后的12个月进行随访，每6个月重新评估心理社会因素和临床危险因素。利用这些数据，我们将估计监禁对心血管危险因素的直接和间接潜在影响，以及这些影响的介导途径。我们还将对与监禁相关的预期10年CVD发病率、医疗保健使用和死亡率负担进行建模。
我们的研究将确定与从监禁中获释人员的CVD危险因素控制相关的因素。我们对与监禁相关的暴露、心理社会因素以及心血管风险的临床测量，将有助于确定在这一弱势群体中改变CVD风险的独特干预目标。
