Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort.
Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control.



Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we used logistic regression models adjusted for sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications.



Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated.



Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes.
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA. benjamin.howell@yale.edu.
Benjamin A
BA
Howell
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.
Jessica B
JB
Long
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
E Jennifer
EJ
Edelman
Veterans Administration Connecticut Healthcare System, West Haven, CT, USA.
Kathleen A
KA
McGinnis
Atlanta VA Medical Center, Atlanta, GA, USA.|Emory University School of Medicine, Atlanta, GA, USA.
David
D
Rimland
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
David A
DA
Fiellin
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.|Veterans Administration Connecticut Healthcare System, West Haven, CT, USA.
Amy C
AC
Justice
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208030, New Haven, CT, 06520, USA.
Emily A
EA
Wang
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D000066479:Criminal Behavior / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D014728:Veterans / Q000523:psychology*
D000959:Antihypertensive Agents
chronic disease/epidemiology; chronic disease/therapy; hypertension/epidemiology; hypertension/therapy; incarceration; prisoners; socioeconomic factors