Cardiovascular Disease Risk Factor Control Following Release from Carceral Facilities

Background: Incarceration 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. Methods: Using 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. Results: Participants (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 Life's 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). Discussion: Release 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. ### Competing Interest Statement Dr Harlan Krumholz reported receiving expenses and/or personal fees from Element Science, Eyedentify, and F-Prime, and is a co-founder of Hugo Health, Refactor Health, and Ensight-AI. He is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from Janssen, Johnson & Johnson Consumer, and Pfizer, outside the submitted work. No other disclosures were reported. ### Clinical Trial Not applicable ### Funding Statement This work is supported by the National Heart, Lung, and Blood Institute grant R01 HL137696, awarded to Dr. Emily Wang. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Yale Human Investigation Committee and the Office of Human Research Protections approved this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the principal investigator (EAW) upon reasonable request.