A prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology – JUSTICE study): a protocol paper

Abstract

Background 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. Methods and Analysis 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. Discussion 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.

Cardiovascular Disease Risk Factor Control Following Release from Carceral Facilities

“…This study uses data from a prospective, observational cohort, JUST ice-Involved I ndividuals C ardiovascular Disease E pidemiology (JUSTICE, R01 HL137696), whose protocol has been described in detail previously. 22 Briefly, we recruited individuals released from a carceral facility to New Haven, Bridgeport, and Hartford, Connecticut. Connecticut is one of six states in the country with a unified prison and jail system (prisons house people incarcerated for sentences longer than one year, and jails house those awaiting adjudication of crime or people with sentences of less than a year, in general) and has one of the highest racial disparities in sentencing in the country (over 70% of the incarcerated population are Black and Latino individuals).…”

The Association Between Civil Legal Needs After Incarceration, Psychosocial Stress, and Cardiovascular Disease Risk Factors

“…Our data were collected as part of the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, an ongoing prospective cohort study of formerly incarcerated individuals residing in New Haven, Bridgeport, and Hartford, Connecticut with known CVD risk factors. 12 The study, which some authors of this paper began in 2019, aims to recruit 500 participants within three months of their release from jail or prison and follow them for 12 months. At baseline, the study assesses each participant for control of CVD risk factors through point-of-care testing that includes a blood lipid panel and hemoglobin A1C, a test of diabetes; direct blood pressure measurements; and detailed questions about diet, exercise, and smoking.…”

Cardiovascular risk assessment of people living in prison in the Northern region of Ghana

“…Previous studies have shown that CVDs and cancer are among the leading causes of death in prisons, exacerbated by the presence of pre-existing poor health conditions of PLP who are mostly from marginalised groups in society (Wang et al , 2017; Howell et al , 2022). Limited access to health-care services and a higher prevalence of risk behaviours such as illicit drug use, alcohol abuse and tobacco use further contribute to the high burden of NCDs among PLP, particularly in sub-Saharan Africa (Todrys et al , 2011; Topp et al , 2016).…”