Improving Cardiovascular Outcomes in Individuals with a History of Incarceration

描述（由申请人提供）：Emily Wang博士，医学博士，是耶鲁大学的一名普通内科医生，她正在进行以患者为导向的研究，以减少有监禁史的患者的心血管疾病。美国是世界上监禁率最高的国家，有1300多万人被关押在监狱或监狱中。现在和以前的囚犯是不成比例的少数民族，贫穷，并且有药物滥用和精神疾病的合并症。有监禁史的患者心血管疾病发病率和死亡率的风险增加，尽管其具体机制尚不清楚。王博士的目标是了解如何预防和减轻有监禁史的患者的心血管疾病；这一建议将支持她的专业发展，使她能够实现成为一名独立临床研究者的目标。她将获得一个由高成就的研究人员组成的多学科团队的指导，以实现她的培训和研究计划。王博士为K23提出的培训目标是培养以下方面的技能：(1)纵向数据分析的先进统计技术；(2)定性和混合（定性和定量）方法；(3)纵向患者队列的设计、招募和管理；(4)与监禁人群相关的心血管疾病和药物滥用测量的多学科培训。她之前的研究表明，即使在调整了混杂因素后，有嵌顿史也是发生高血压和左心室肥厚的独立风险因素。此外，她还发现，有心血管风险因素和疾病的人从惩教设施释放后很难获得社区卫生保健。Wang博士的研究计划建立在她过去的临床和研究经验的基础上，并探讨了可能影响从惩教设施释放的心血管危险因素和疾病患者健康结果的三个特定人群因素。第一个项目将使用来自nhlbi资助的年轻人冠状动脉风险发展（CARDIA）队列（5115名年轻人）25年的数据，研究监禁对心血管危险因素累积发病率和长期疾病控制的影响，以及观察到的关联的潜在介质。第二个项目是一项调查研究，旨在检查监狱卫生保健系统中心血管危险因素和疾病护理的性质。第三个项目将评估50名最近获释的囚犯对其心血管危险因素的知识、态度和信念，采用既定的工具和深度访谈，其次，将对这些人进行12个月的随访，以评估未来前瞻性队列研究的可行性。该奖项申请中提出的研究将为R01提供初步数据，以进行更大规模的前瞻性队列研究，以确定未来干预研究的目标，旨在降低越来越多有监禁史的成年人的心血管发病率和死亡率。

DESCRIPTION (provided by applicant): Dr. Emily Wang, MD, MAS is a general internist at Yale University who is conducting patient oriented research to reduce cardiovascular disease in patients with a history of incarceration. The United States has the highest rate of incarceration worldwide, such that more than 13 million individuals have been incarcerated in jail or prison. Current and former inmates are disproportionately ethnic minorities, poor, and have co-morbid substance abuse and psychiatric disorders. Patients with a history of incarceration are at increased risk for cardiovascular disease morbidity and mortality, although the specific mechanisms for this are unknown. Dr. Wang's goal is to understand how to prevent and mitigate cardiovascular disease in patients with a history of incarceration; this proposal will support her professional development and allow her to achieve her goal of becoming an independent clinical investigator. She will enlist the mentorship of a multidisciplinary team of highly accomplished researchers to achieve her training and research plans. Dr. Wang's training goals proposed for the K23 are to develop skills in: (1) advanced statistical techniques for longitudinal data analyses, (2) qualitative and mixed (qualitative and quantitative) methods, (3) design, recruitment, and management of a longitudinal patient cohort, and (4) multidisciplinary training in the measurement of cardiovascular disease and substance abuse as it relates to incarcerated populations. Her prior research has shown that having a history of incarceration is an independent risk for developing hypertension and left ventricular hypertrophy, even after adjusting for confounding factors. Moreover, she has found that individuals with cardiovascular risk factors and disease have poor access to community health care upon release from correctional facilities. Dr. Wang's research plan for this application builds on her past clinical and research experience and explores three population-specific factors that may affect health outcomes in patients released from correctional facilities with cardiovascular risk factors and disease. The first project will use 25 years of data from the NHLBI-funded Coronary Artery Risk Development in Young Adults (CARDIA) cohort of 5115 young adults to study the impact of incarceration on the cumulative incidence of cardiovascular risk factors and long-term disease control and potential mediators of observed associations. The second project is a survey study designed to examine the nature of cardiovascular risk factors and disease care in prison health care systems. The third project will assess 50 recently released prisoners' knowledge, attitudes, and beliefs regarding their cardiovascular risk factors using both established instruments and in-depth interviews and, secondarily, will follow these individuals for 12 months to assess the feasibility of a future prospective cohort study. The studies proposed within this award application will provide preliminary data for an R01 to conduct a larger prospective cohort study to identify targets for future intervention studies designed to reduce cardiovascular morbidity and mortality in the growing number of adults with a history of incarceration. PUBLIC HEALTH RELEVANCE: Current and former inmates with cardiovascular risk factors and disease typically fall at the intersection of two poorly functioning health care systems: the correctional health care system and the public safety net health care system. Neither health care system is well equipped to take care of this growing population of individuals who cycle in and out of both systems. By studying three areas that impact the cardiovascular outcomes of returning inmates, the proposed studies will provide valuable information on modifiable risk factors and targets for interventions to reduce cardiovascular disease in patients with a history of incarceration and reduce health care costs in correctional facilities and in the community.