JUSTice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE)

项目摘要 有监禁史的人有较高的心血管疾病（CVD）发病率， 死亡率与一般人口相比，特别是在从教养所释放后的几周内， 设施，但驱动观察到的CVD发病率较高的因素是未知的。考虑到不成比例的 贫困和种族/族裔少数群体的监禁，迫切需要了解 有监禁史的人中的CVD。在这些机制被定义之前，我们将无法 确定有效和持久的干预措施，以减轻心血管疾病的发病率和死亡率， 年轻的成年人。这一应用的长期目标是降低发病率和死亡率， 有监禁史和CVD风险因素的人。下一步的总体目标是 为了实现这一长期目标，是设计第一个纵向观察研究的个人， 从惩教机构释放，以便了解心血管疾病危险因素的流行病学， CVD危险因素控制的可变介质。JUSTice参与个体研究的中心假设 心血管疾病流行病学（正义）的一个重要特征是，有人群特异性风险因素影响 传统CVD危险因素控制不佳，这反过来又导致CVD发病率和死亡率增加 释放后。初步数据表明，受到更严格的监禁政策的影响， 慢性感知压力和较低水平的自我效能，这反过来又有助于更高的心血管疾病风险。测试 中心假设，该建议解决三个目标：（1）检查人口之间的联系- 特定的危险因素和CVD危险因素控制（高血压，高脂血症，糖尿病， 和肥胖），（2）评估人群特异性风险因素随时间的变化如何影响CVD风险因素 （3）估计人群特异性风险因素对长期CVD发病率的影响， mortality.因为没有正在进行的或过去的流行病学研究使我们能够验证这一假设， 500名刚从康涅狄格州教养所释放的人将在为期一年的时间里被招募， 队列研究，探讨心理社会压力，自我效能感和暴露于 监禁相关政策和CVD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，将生成这些因素对10年心血管疾病影响的估计 发病率和死亡率。司法代表着一种新的和实质性的脱离现状的转变， 重点关注主要数据收集，以评估最近从 惩教设施。这将是第一项研究，以审查监禁和 CVD危险因素控制，并模拟监禁对CVD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.