Larrabee Sonderlund Anders, Wang Emily A, Williams Natasha J, Horowitz Carol R, Schoenthaler Antoinette, Holaday Louisa W
Center for Healthful Behavior Change Institute for Excellence in Health Equity, NYU Grossman School of Medicine New York NY USA.
Research Unit of General Practice, Department of Public Health University of Southern Denmark Odense Denmark.
J Am Heart Assoc. 2025 May 20;14(10):e039065. doi: 10.1161/JAHA.124.039065. Epub 2025 May 13.
Few studies assess the association between county-level incarceration rates and stroke death, and none test mechanisms. We examine the link between county imprisonment rates and stroke death, testing pathways and identifying racial disparities.
In a cross-sectional design, we regressed stroke death onto imprisonment rates, adjusting for poverty, racial composition, education, unemployment, insurance, and violent crime. Using bootstrap methodology, we tested mediation through sports/recreational facilities and food environment, mental health provider and primary care physician (PCP) access, and community mental distress. Data spanned 4 years (2016-2019) and included 2260 counties.
Adjusted models indicated a 0.08 (95% CI, 0.05-0.10) increase in stroke deaths for every 1-unit change in imprisonment rate. This association was mediated by food environment (indirect effect, 0.006 [95% CI, 0.000-0.014]), primary care physician access (indirect effect, 0.002 [95% CI, 0.000-0.006]), and mental distress (indirect effect, 0.014 [95% CI, 0.007-0.022]). Counties in the top versus bottom quintile of imprisonment rates had 86.26% larger Black populations and 23.46% smaller White populations. Counties in the top versus bottom quintile of stroke death had 88.94% larger Black populations and 16.19% smaller White populations.
Our results complement evidence that living in high-jail-incarceration counties contributes to stroke death and associated racial disparities. We provide new evidence on prison incarceration rates and the pathways underpinning this association. County-level imprisonment rates and the identified mechanisms represent avenues for further research into how stroke death and disparities may be mitigated.
很少有研究评估县级监禁率与中风死亡之间的关联，且没有一项研究检验其中的机制。我们研究县级监禁率与中风死亡之间的联系，检验其路径并识别种族差异。
在一项横断面设计中，我们将中风死亡情况对监禁率进行回归分析，并对贫困、种族构成、教育程度、失业率、保险和暴力犯罪进行了调整。使用自助法，我们检验了通过体育/娱乐设施和食物环境、心理健康服务提供者和初级保健医生（PCP）的可及性以及社区心理困扰所产生的中介作用。数据涵盖4年（2016 - 2019年），包括2260个县。
调整后的模型显示，监禁率每变化1个单位时，中风死亡人数增加0.08（95%置信区间，0.05 - 0.10）。这种关联通过食物环境（间接效应，0.006 [95%置信区间，0.000 - 0.014]）、初级保健医生的可及性（间接效应，0.002 [95%置信区间，0.000 - 0.006]）和心理困扰（间接效应，0.014 [95%置信区间，0.007 - 0.022]）产生中介作用。监禁率处于最高五分位数的县与最低五分位数的县相比，黑人人口多86.26%，白人人口少23.46%。中风死亡处于最高五分位数的县与最低五分位数的县相比，黑人人口多88.94%，白人人口少16.19%。
我们的结果补充了以下证据，即生活在高监禁率的县会导致中风死亡及相关的种族差异。我们提供了关于监狱监禁率及其背后关联路径的新证据。县级监禁率和所确定的机制为进一步研究如何减轻中风死亡及差异提供了途径。
