Living in a High Incarceration US County Increases Risk for Stroke Death

Individuals living in high-jail-incarceration counties are at higher risk for stroke death, according to results of a study published in the Journal of the American Heart Association.

Investigators from the University of Southern Denmark in Denmark and Icahn School of Medicine at Mount Sinai in the United States hypothesized that county-level imprisonment and stroke death rates are positively related and that this relationship is mediated by environmental factors, health care access factors, and community mental distress.

To test their hypotheses, publicly available data were pooled using Federal Information Processing Standards county codes in the US. The county-level stroke mortality rate among adults aged 35 years or older in 2018 and 2019 was associated with the county-level imprisonment rate of individuals aged 15 to 64 years in 2016. The models were adjusted for racial composition, education, unemployment, insurance, poverty, and violent crime variables and the mediation effect of access to sports and recreational facilities, the Food Environment Index (FEI), access to mental health providers (MHPs) and primary care physicians (PCPs), and community mental distress were considered.

Data from 2260 (72.2%) counties with 265,712,030 (80%) residents were included in this analysis.

The median stroke mortality rate was 75.30 per 100,000 population and imprisonment rate was 613.33 per 100,000 population.

Black individuals were imprisoned at a rate that was over 4 times higher than White individuals, and counties with higher imprisonment rates had more Black residents. This trend was similar among Hispanic and American Indian or Alaska Native populations but to a lesser extent.

Counties with higher imprisonment rates had more poverty, higher unemployment, more violent crime, a lower insurance coverage rate, and lower rate of post-high school education (all P £.010).

For every 1-SD increase in the imprisonment rate, the stroke mortality rate increased by 0.10-SD (P <.01).

In the model with covariates, stroke mortality increased with every 1-SD increase in the imprisonment rate (b, 0.08; P <.01), the poverty rate (b, 0.07; P <.01), the proportion of Black residents (b, 0.06; P <.01), and the violent crime rate (b, 0.03; P <.05).

In the mediation analysis, higher imprisonment rates were associated with lower FEI (b, -0.07; P <.01) and access to sports and recreation facilities (b, -0.05; P <.01) and more community mental distress (b, 0.06; P <.01). Consequently, higher community mental distress (b, 0.11; P <.01) and worse FEI (b, -0.10; P <.01), access to sports and recreation facilities (b, -0.08; P <.01), access to PCPs (b, -0.04; P <.01), and access to MHPs (b, -0.03; P <.05) resulted in higher stroke mortality.

Community mental distress (b, 0.014; P <.05), FEI (b, 0.006; P <.01), and access to PCPs (b, 0.002; P <.05) also had indirect mediation effects.

This study was of a cross-sectional design, so no causal inferences could be made.

The study authors concluded, “Living in a county with high imprisonment rates is independently associated with stroke death and may explain at least some of the associated racial disparities.”

This article originally appeared on The Cardiology Advisor