Incarceration Is Associated With Psychosocial Factors That May Increase Cardiovascular Risk

 

Incarceration may augment socioeconomic disadvantage, which is independently associated with the development of cardiovascular disease. Individuals released from prison and jail often face additional barriers to obtaining employment, housing, and public entitlements and encounter various restrictions of their political rights (Travis 2005), which may further impede access to healthcare and medical treatment. Current and former inmates have been found to have higher levels of anger and hostility (Cuomo et al. 2008) which are associated with significant increases in angina, myocardial infarction, and angiographic severity of cardiovascular disease (Iribarren et al. 2000). Those with a history of incarceration may suffer from social isolation (Mallik-Kane and Visher 2008), which has also been linked to higher total mortality independent of cardiovascular risk factors. A related issue is that patients receiving psychotropic medications (e.g., olanzapine) are at increased risk of diabetes and, given the high rates of mental illness among the incarcerated, psychotropic medicine use is more common than in the general community. Another plausible mechanism that has not been studied is current and former inmates’ health beliefs and attitudes about cardiovascular risk factors and disease. Research in minority and vulnerable populations has demonstrated that disparate patient adherence to health-supporting behaviors (exercising, eating a healthy diet, taking medications as directed, avoiding illicit substance abuse) is an important component of racial disparities in cardiovascular outcomes. Given the disproportionate incarceration of poor minority populations, this likely plays a role in the increased risk of cardiovascular risk factors and disease of ever-incarcerated populations.