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Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Emily A. Wang, MD; Mark Pletcher, MD, MPH; Feng Lin, MS; Eric Vittinghoff, PhD, MPH; Stefan G. Kertesz, MD, MSc; Catarina I. Kiefe, MD, PhD; Kirsten Bibbins-Domingo, PhD, MD

Arch Intern Med. 2009;169(7):687-693.

Background  Incarceration is associated with increased cardiovascular disease mortality, but prospective studies exploring mechanisms of this association are lacking.

Methods  We examined the independent association of prior incarceration with incident hypertension, diabetes, and dyslipidemia using the Coronary Artery Risk Development in Young Adults (CARDIA) study—a cohort of young adults aged 18 to 30 years at enrollment in 1985-1986, balanced by sex, race (black and white), and education (high school education or less). We also examined the association of incarceration with left ventricular hypertrophy on echocardiography and with barriers to health care access.

Results  Of 4350 participants, 288 (7%) reported previous incarceration. Incident hypertension in young adulthood was more common among former inmates than in those without incarceration history (12% vs 7%; odds ratio, 1.7 [95% confidence interval {CI}, 1.2-2.6]), and this association persisted after adjustment for smoking, alcohol and illicit drug use, and family income (adjusted odds ratio [AOR], 1.6 [95% CI, 1.0-2.6]). Incarceration was significantly associated with incident hypertension in those groups with the highest prevalence of prior incarceration, ie, black men (AOR, 1.9 [95% CI, 1.1-3.5]) and less-educated participants (AOR, 4.0 [95% CI, 1.0-17.3]). Former inmates were more likely to have left ventricular hypertrophy (AOR, 2.7, [95% CI, 0.9-7.9]) and to report no regular source for medical care (AOR, 2.5, [95% CI, 1.3-4.8]). Cholesterol levels and diabetes rates did not differ by history of incarceration.

Conclusions  Incarceration is associated with future hypertension and left ventricular hypertrophy among young adults. Identification and treatment of hypertension may be important in reducing cardiovascular disease risk among formerly incarcerated individuals.

Author Affiliations: Division of General Internal Medicine, San Francisco General Hospital (Drs Wang and Bibbins-Domingo), Department of Medicine (Drs Wang, Pletcher, and Bibbins-Domingo), Department of Epidemiology and Biostatistics (Drs Pletcher, Vittinghoff, and Bibbins-Domingo and Ms Lin), and Center for Vulnerable Populations (Dr Bibbins-Domingo), University of California, San Francisco; and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (Drs Kertesz and Kiefe). Dr Wang is now with the Division of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

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