Improving Cardiovascular Outcomes in Individuals with a History of Incarceration

描述(申请人提供)：艾米丽·王博士，医学博士，MAS，耶鲁大学的普通内科医生，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多万人被关在监狱里。现任和前任囚犯不成比例地是少数民族，贫穷，并患有药物滥用和精神障碍。有监禁史的患者心血管疾病发病率和死亡率的风险增加，尽管具体机制尚不清楚。王医生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；这项建议将支持她的职业发展，并让她实现成为一名独立临床研究员的目标。她将招募一个由高度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提出的培训目标是发展以下方面的技能：(1)用于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，以及(4)在衡量心血管疾病和药物滥用方面的多学科培训，因为它与被监禁人口有关。她之前的研究表明，即使在调整了混杂因素后，有监禁史也是患高血压和左心室肥厚的独立风险。此外，她还发现，有心血管危险因素和疾病的人在从教养机构释放后很难获得社区卫生保健。王博士的这一应用研究计划建立在她过去的临床和研究经验的基础上，并探索了三个特定人群的因素，这些因素可能会影响有心血管风险因素和疾病的惩教机构出院患者的健康结果。第一个项目将使用NHLBI资助的青年冠状动脉风险发展(CARDIA)队列中5115名年轻人25年的数据，研究监禁对心血管风险因素和长期疾病控制的累积发生率的影响，以及观察到的关联的潜在介体。第二个项目是一项调查研究，旨在检查监狱保健系统中心血管危险因素和疾病护理的性质。第三个项目将使用已建立的工具和深度访谈来评估50名最近获释的囚犯关于其心血管风险因素的知识、态度和信念，其次，将对这些人进行为期12个月的跟踪调查，以评估未来前瞻性队列研究的可行性。本奖项申请中提出的研究将为R01进行更大规模的前瞻性队列研究提供初步数据，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。

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.