JUSTice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE)

项目总结 有监禁史的人心血管疾病(CVD)发病率较高， 死亡率与一般人口的比较，特别是在从教养所释放后的几周内 设施，但驱动观察到的心血管疾病发病率较高的因素尚不清楚。考虑到不成比例的 在监禁穷人和种族/少数族裔的情况下，迫切需要了解 有监禁史的人中的心血管疾病。在定义这些机制之前，我们将无法 找出有效和持久的干预措施，以减少本地区心血管疾病的发病率和死亡率 青壮年人口。这项应用的长期目标是降低 有监禁史和心血管疾病危险因素的个人。总体目标，这是下一步 为了实现这一长期目标，设计了第一个纵向观察性研究的个体 从教养所释放，以便了解心血管疾病危险因素和 心血管疾病危险因素控制的可修改介体。正义的中心假说涉及个人化研究 心血管疾病流行病学(正义)的结论是，有特定于人群的危险因素会影响 对传统心血管疾病风险因素控制不力，进而导致心血管疾病发病率和死亡率增加 在获释后。初步数据显示，暴露于更严格的监禁政策会导致更高水平的 慢性感受到的压力和较低的自我效能感，进而导致更高的心血管疾病风险。为了测试 该提案的核心假设是解决三个目标：(1)研究人口-- 心血管疾病危险因素控制的具体危险因素和临床证据(高血压、高脂血症、糖尿病、 和肥胖)，(2)评估特定人群风险因素随时间的变化如何影响心血管疾病风险因素 控制，以及(3)估计特定人群的危险因素对长期心血管疾病发病率和 死亡率。因为没有正在进行的或过去的流行病学研究使我们能够检验这一假说， 500名刚从康涅狄格州惩教所释放的人将在为期一年的预期中被招募 探讨心理社会压力、自我效能感和暴露于空气中的关系的队列研究 与监禁相关的政策和心血管疾病风险因素控制，然后使用 电子健康记录。这些数据将被纳入心血管疾病政策模型， 心血管疾病风险预测模型，该模型将对这些因素对10年期心血管疾病的影响进行估计 发病率和死亡率。正义代表着对现状的新的和实质性的背离，通过改变 关注初级数据收集，以评估最近发布的人群中心血管疾病风险因素控制情况 惩教所。这将是第一个研究监禁和监禁之间的时间关系的研究。 控制心血管疾病危险因素，并模拟监禁对心血管疾病发病率和死亡率的影响。

PROJECT SUMMARY Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) morbidity and mortality compared to the general population, especially in the weeks following release from correctional facilities, but factors driving observed higher rates of CVD morbidity are unknown. Given the disproportionate incarceration of poor and racial/ethnic minorities, there is an urgent need to understand the epidemiology of CVD among individuals with a history of incarceration. Until these mechanisms are defined, we will not be able to identify effective and durable interventions to mitigate CVD morbidity and mortality in this substantial population of young adults. The long-term goal of this application is to reduce morbidity and mortality among individuals with a history of incarceration and CVD risk factors. The overall objective, which is the next step toward achieving this long-term goal, is to design the first longitudinal observational study of individuals who are released from a correctional facility, so as to understand the epidemiology of CVD risk factors and modifiable mediators of CVD risk factor control. The central hypothesis of JUSTice Involved Individuals Study of Cardiovascular Disease Epidemiology (JUSTICE) is that there are population-specific risk factors that affect poor control of traditional CVD risk factors, which in turn contribute to increased CVD morbidity and mortality upon release. Preliminary data indicate that exposure to stricter incarceration policies results in higher levels of chronic perceived stress and lower levels of self-efficacy, which in turn contributes to higher CVD risk. To test the central hypothesis, the proposal tackles three aims: (1) Examine the association between population- specific risk factors and clinical evidence of CVD risk factor control (hypertension, hyperlipidemia, diabetes, and obesity), (2) Assess how changes in population-specific risk factors over time impact CVD risk factor control, and (3) Estimate the impact of population-specific risk factors on long-term CVD morbidity and mortality. Because there are no ongoing or past epidemiologic studies that enable us to test this hypothesis, 500 individuals just released from a Connecticut correctional facility will be recruited in a year-long, prospective cohort study to explore the associations between psychosocial stress, self-efficacy, and exposure to incarceration-related policies and CVD risk factor control, and then followed for an additional three years using electronic health records. These data will be incorporated into the Cardiovascular Disease Policy Model, a CVD risk prediction model, which will generate estimates of the impact of these factors on 10-year CVD morbidity and mortality. JUSTICE represents a new and substantial departure from the status quo by shifting focus to primary data collection to assess CVD risk factor control among a population recently released from correctional facilities. It will be the first study to examine the temporal relationship between incarceration and CVD risk factor control and to simulate the impact of incarceration on CVD morbidity and mortality.