Impact of incarceration on cardiovascular disease risk factors: a systematic review and meta-regression on weight and BMI change

Abstract

ObjectiveCardiovascular disease is an underappreciated issue in prison medicine. Recent studies have revealed a higher prevalence of cardiovascular disease risk factors (CVDRFs) among individuals in prison, but the impact of incarceration on CVDRFs over time is not well understood. This review aimed to assess available literature and quantify the relationship between incarceration and trends in major CVDRFs in high-income countries.DesignSystematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-regression on weight change and obesity.Data sourcesMedline, Embase, PubMed, Cochrane Central Wiley and Web of Science.Eligibility criteria for selecting studiesLongitudinal studies reporting on the incidence of, or trends in any CVDRF among current or former people in prison over time, in high-income countries.Data extraction and synthesisTwo authors independently screened articles for eligibility, extracted data and assessed quality using an adapted version of the Newcastle-Ottawa Scale. Trends in CVDRFs during and following incarceration were summarised and in those with sufficient data a meta-regression was performed.ResultsTwenty-six articles were identified. CVDRFs assessed included obesity, hypertension, diabetes, dyslipidaemia, tobacco use, physical inactivity and unhealthy diet. A meta-regression on change in weight during incarceration found a mean increase of 5.3 kg (95% CI 0.5 to 10.1) and change in body mass index of 1.8 kg/m2 (95% CI −0.9 to 4.6) at 2 years. Weight gain appeared most pronounced right after entering prison and then plateaued at 2 years. Concerning hypertension, the results were inconclusive, despite a trend towards rising blood pressure or prevalence of hypertension during incarceration, and an increased incidence of hypertension following incarceration. Results are contradictory or inconclusive for the other CVDRFs reviewed.ConclusionPossible explanations for the association between incarceration and weight include a sedentary lifestyle, unhealthy diet, forced smoking cessation, psychotropic medication use and high levels of stress. Incarceration may be an independent risk factor for cardiovascular disease.

Association between incarceration and incident cardiovascular disease events: results from the CARDIA cohort study

“…The hypothesized relationship may be mediated through CVD risk factors included in the multivariable models, which explains the attenuation after adjustment. For example, a 2020 systematic review of 26 longitudinal studies demonstrated that incarcerated individuals were gained, on average, 5.3 kg (95% CI: 0.5–10.1 kg) in weight during their period of incarceration, though the trends in other risk factors were less clear [ 12 ]. Second, losses to follow-up among Black men were higher than among other sex-race groups, and up to 65% of those losses at later examinations may have been due to incarceration [ 13 ], which limits the ability to capture non-fatal cardiovascular disease events occurring during incarceration, including among those with a history of incarceration.…”

“…Previous research has demonstrated associations between prior incarceration and higher burden of CVD risk factors and subclinical CVD, including weight gain during incarceration [ 12 ] and incident hypertension and post-release hospitalization due to CVDs [ 4 , 5 ]. For example, CARDIA data demonstrate a 1.7-fold higher odds of incident hypertension and a 2.7-fold higher odds of left ventricular hypertrophy among those with a history of incarceration [ 5 ].…”

Bricolage as an expression of self and of cultural and familial foodways among people living in prison—‘You make what you can with anything you can get’

“…Discussions of ‘health behaviours’ among prison populations include global examinations of the international burden of non‐communicable diseases such as cardiovascular disease, hypertension and diabetes (Herbert et al., 2012; Bondolfi et al., 2020), substance misuse (Baranyi et al., 2019) and mental health (Fazel et al., 2016; Tweed et al., 2019). While food plays an essential role in the physical and mental health of prison populations, it has been somewhat neglected as an area of enquiry by public health researchers and practitioners (Devine‐Wright et al., 2019; WHO, 2015).…”

Assessment of Satisfaction with Health Services among Prisoners—Descriptive Study

“…The state is responsible for providing total healthcare, and, on average, detainees have a higher morbidity rate, which implies greater healthcare needs than non-detained persons [ 13 , 14 ]. To analyze the health condition of prisoners, the literature takes into account, inter alia, indicators, such as BMI, the occurrence of chronic diseases, and addictions [ 15 , 16 , 17 ].…”