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Incarceration, incident hypertension, and access to health care: findings from the coronary artery risk development in young adults (CARDIA) study
Quantitative Health Sciences Publications and Presentations
  • Emily A. Wang
  • Mark J. Pletcher, University of California
  • Feng Lin, University of California
  • Eric Vittinghoff, University of California
  • Stefan G. Kertesz, University of Alabama
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Kirsten Bibbins-Domingo, University of California
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
Adolescent; Adult; Age Distribution; Cohort Studies; Coronary Disease; Female; Follow-Up Studies; Health Services Accessibility; Humans; Hypertension; Incidence; Longitudinal Studies; Male; Predictive Value of Tests; Prisoners; Prisons; Probability; Questionnaires; Risk Assessment; Sex Distribution; Socioeconomic Factors; Time Factors; United States; Young Adult

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.

DOI of Published Version
Arch Intern Med. 2009 Apr 13;169(7):687-93. Link to article on publisher's site
PubMed ID
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Link to Article in PubMed
Citation Information
Emily A. Wang, Mark J. Pletcher, Feng Lin, Eric Vittinghoff, et al.. "Incarceration, incident hypertension, and access to health care: findings from the coronary artery risk development in young adults (CARDIA) study" Vol. 169 Iss. 7 (2009) ISSN: 0003-9926 (Linking)
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