Improving Cardiovascular Outcomes in Individuals with a History of Incarceration

描述（由申请人提供）：艾米丽王博士，医学博士，MAS是耶鲁大学的一名普通内科医生，他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，有超过1300万人被监禁在监狱或监狱中。目前和以前的囚犯不成比例地是少数民族、穷人，并患有药物滥用和精神疾病。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;该提案将支持她的专业发展，并使她能够实现成为独立临床研究者的目标。她将争取一个多学科团队的高度成就的研究人员的指导，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）纵向数据分析的高级统计技术，（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，以及（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。她先前的研究表明，即使在调整了混杂因素后，有监禁史也是发展高血压和左心室肥大的独立风险。此外，她还发现，有心血管风险因素和疾病的人在从教养设施释放后很难获得社区保健。王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，并探讨了三个可能影响心血管危险因素和疾病患者从惩教机构释放的健康结果的人群特异性因素。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）队列的5115名年轻人的25年数据，研究监禁对心血管危险因素累积发生率和长期疾病控制的影响。第二个项目是一项调查研究，旨在审查监狱保健系统中心血管风险因素和疾病护理的性质。第三个项目将评估50名最近获释的囚犯的知识，态度和信念，对他们的心血管疾病的危险因素，使用既有工具和深入的访谈，其次，将这些人跟踪12个月，以评估未来的前瞻性队列研究的可行性。本奖项申请中提出的研究将为R 01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，旨在减少越来越多有监禁史的成年人的心血管发病率和死亡率。 公共卫生相关性：患有心血管风险因素和疾病的现任和前任囚犯通常处于两个运作不良的医疗保健系统的交叉点：惩教医疗保健系统和公共安全网医疗保健系统。这两个卫生保健系统都没有很好的装备来照顾不断增长的进出这两个系统的人口。通过研究影响返回囚犯的心血管结局的三个领域，拟议的研究将提供有关可改变的风险因素和干预目标的宝贵信息，以减少有监禁史患者的心血管疾病，并减少惩教机构和社区的医疗保健费用。

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.