Incarceration, incident hypertension, and access to health care: findings from the coronary artery risk development in young adults (CARDIA) study

Abstract

Background: Incarceration is associated with increased cardiovascular disease mortality, but prospective studies exploring mechanisms of this association are lacking.

Methods: We examined the independent association of prior incarceration with incident hypertension, diabetes, and dyslipidemia using the Coronary Artery Risk Development in Young Adults (CARDIA) study-a cohort of young adults aged 18 to 30 years at enrollment in 1985-1986, balanced by sex, race (black and white), and education (high school education or less). We also examined the association of incarceration with left ventricular hypertrophy on echocardiography and with barriers to health care access.

Results: Of 4350 participants, 288 (7%) reported previous incarceration. Incident hypertension in young adulthood was more common among former inmates than in those without incarceration history (12% vs 7%; odds ratio, 1.7 [95% confidence interval {CI}, 1.2-2.6]), and this association persisted after adjustment for smoking, alcohol and illicit drug use, and family income (adjusted odds ratio [AOR], 1.6 [95% CI, 1.0-2.6]). Incarceration was significantly associated with incident hypertension in those groups with the highest prevalence of prior incarceration, ie, black men (AOR, 1.9 [95% CI, 1.1-3.5]) and less-educated participants (AOR, 4.0 [95% CI, 1.0-17.3]). Former inmates were more likely to have left ventricular hypertrophy (AOR, 2.7, [95% CI, 0.9-7.9]) and to report no regular source for medical care (AOR, 2.5, [95% CI, 1.3-4.8]). Cholesterol levels and diabetes rates did not differ by history of incarceration.

Conclusions: Incarceration is associated with future hypertension and left ventricular hypertrophy among young adults. Identification and treatment of hypertension may be important in reducing cardiovascular disease risk among formerly incarcerated individuals.

Figure 1

Association of incarceration history before 1987 with subsequent incident hypertension (1990–91) at age 23–35 *Adjusted for traditional clinical risk factors for hypertension including body mass index, smoking, excessive alcohol consumption, and illicit drug use, including cocaine and amphetamine use. The areas under the curve for models including all participants ranged from 0.52–0.68. The interaction terms between incarceration and race (p=0.77), incarceration and sex (p=0.15), and incarceration and educational level (p=0.22) are not statistically significant.