Incarceration Can Cause Poorer Cardiovascular Health, Says Rutgers–Camden Study

By Tom McLaughlin People who experience incarceration have poorer cardiovascular health across a wide range of indicators, especially poor diet, smoking, and high blood pressure, according to new Rutgers University–Camden research.

“We found the effects to be particularly damaging among white men and women compared to their Black counterparts,” says co-author Dan Semenza, an assistant professor at Rutgers–Camden.

Semenza and research co-authors Alexander Testa, from the University of Texas; Dylan Jackson, from Johns Hopkins University; and Michael Vaughn, from St. Louis University, examine the pathways through which incarceration leads to poorer cardiovascular health in their paper, “Incarceration and Cardiovascular Health: Multiple mechanisms within an intersectional framework,” published in the Journal of Criminal Justice.

The researchers used data from the Add Health study – an extensive, nationally representative longitudinal survey – to assess the relationship between incarceration and a composite measure of cardiovascular health. The expansive survey began following adolescents in 1994 and follows up with them periodically to release new waves of data. The researchers looked specifically at wave four, when the participants ranged from 24 to 34 years of age.

Semenza notes that the new cardiovascular health study is novel in that it takes into account self-report indicators – personal responses about health – as well as biomarker indicators, including blood pressure, cholesterol levels, and blood glucose.

“We were able to put all of these different dimensions together,” says Semenza. “It creates a really multidimensional way of thinking about heart health that is more than just looking at blood pressure or BMI separately.”

While previous studies have shown poor heart health among people who have been incarcerated, this new Rutgers University–Camden study dives deeper to determine the underlying mechanisms, such as material hardship, drug dependence, and poor access to health care, which help explain why that is the case.

Dan Semenza

“All of these indicators, which are consequences or ‘fallout’ from incarceration experiences, now show a correspondence to poor heart health as well,” he says.

Semenza further notes that the study is also unique in that it uses an intersectional framework to consider how these underlying mechanisms might differ across groups defined by both race and gender.

“Various populations are affected by incarceration differently, so it’s important to think about how the groups we belong to can influence how incarceration affects health,” he says.

For instance, says the Rutgers–Camden researcher, he was surprised to find that white men and women experience the greatest negative impact of incarceration on cardiovascular health. He posits that Black men or women living in disadvantaged communities may have less access to quality healthcare or health insurance. So individuals in these groups may actually receive better health care while they are incarcerated than they normally receive outside of prison.

For white women in particular, he continues, stress, material hardship, and drug dependence appear to be key drivers of poor cardiovascular health after incarceration.

Semenza notes that additional research needs to be done to “tease out” the data and determine what exactly is driving these health outcomes. For example, he says, people who come out of prison might have a more difficult time “getting on their feet,” resulting in greater material hardship – difficulty meeting basic human needs.

“It is a lot harder to find stability after coming home from prison, which is really important for stress and all of the other factors that affect one’s well-being, including cardiovascular health,” says Semenza.

The Rutgers–Camden researcher adds that the findings show why it is critical to include health considerations when discussing a support system for people leaving prison. He argues that issues such as employment, housing, and child support are extremely critical for people returning home, but health – and health insurance – needs to be a bigger part of that conversation.

“Are formerly incarcerated people going to be able to access proper nutrition, find health insurance, or be able to get on a smoking cessation program?” he asks. “The criminal justice system is a big driver of health disparities in this country, so health needs to be discussed. If it isn’t, we are going to continue to see poorer health outcomes for those that have been incarcerated.”