Abundance of undiagnosed cardiometabolic risk within the population of a long-stay prison in the UK

Prevalence of overweight and obesity in incarcerated individuals in developed and developing countries: A systematic review and meta-analysis

We systematically assessed evidence of overweight and obesity prevalence, and possible determinants, in people who experience incarceration globally. We searched Embase, Medline, and Cochrane databases. Overweight and obesity proportions were pooled into a meta-analysis and compared with national prevalences. Seventy-one studies met the inclusion criteria; 38 were included in the meta-analysis. Studies in high-income countries reported higher proportions of overweight and obesity (73.3%, 95% CI 73.1, 73.5) than upper-middle-income countries (66.1%, 95% CI 64.1, 67.7) and lower-middle-income countries (52.8%, 95% CI 47.1, 58.1). The prevalence of overweight and obesity in female incarcerated individuals was higher than that in the general population (RD 11.7%, 95% CI 9.1, 14.3), especially in low and middle-income countries (RD 35.1%, 95% CI 29.4, 40.7). The prevalence of overweight and obesity in male incarcerated individuals was lower than that in the general population in all income categories (RD -10.8%, 95% CI -13.2, -8.4). Incarcerated individuals in low and lower-middle-income countries were less likely to achieve sufficient energy intake, fruit/vegetable intake, and sufficient physical activity, compared with high- and upper-middle-income countries. The prevalence of overweight and obesity in incarcerated populations differed between developed and developing countries. Future research should focus on female incarcerated individuals, especially in lower-middle-income countries.

Health behind bars: obesity and cardiometabolic risk according to different indicators in incarcerated men

PURPOSE

This study aims to evaluate the obesity and cardiometabolic disease risks of incarcerated men and to determine the related factors.

DESIGN/METHODOLOGY/APPROACH

This study was cross-sectional and 139 incarcerated men were included. Data were collected using a questionnaire containing the Descriptive Information Form and the Pittsburgh Sleep Quality Index. The incarcerated men' body mass index (BMI), waist circumference, waist-to-hip ratio and waist-to-height ratio were evaluated. The significance level of statistical tests was accepted as p < 0.05.

FINDINGS

According to BMI, the rates of incarcerated men with overweight were 53.2% and with obesity were 13.7%. Their cardiometabolic disease risk according to waist circumference, waist-to-hip ratio and waist-to-height ratio was 47.5%, 53.2% and 73.4%, respectively. The cardiometabolic disease risk was 2.66 times higher in the married and 3.71 times higher in those with senior high school or lower education according to waist circumference, and 4.16 times higher in those who were in the aged = 40 years according to the waist-to-hip ratio, 3.49 times higher in those who were in the aged = 40 years and 4.26 times higher in those with senior high school or lower education according to the waist-to-height ratio.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is the first study in which obesity and the risk of cardiometabolic disease in incarcerated men was investigated in Türkiye. In the incarcerated individuals, there was an association between the increased cardiometabolic diseases risk and variables such as older age, being married and having senior high school or lower education.

Rates of Cardiovascular Events in the Justice System: An Unknown Problem

People who experience incarceration have a heightened risk for cardiovascular disease (CVD) mediated by both traditional and incarceration-specific risk factors related to their environment. In this Viewpoint, we summarize what is known about the epidemiology and management of acute CV events, specifically acute myocardial infarction (AMI), congestive heart failure exacerbation (CHFe), and stroke, among people who are incarcerated. We also highlight gaps in available evidence. Our literature review found no studies that provided population-based rates (e.g., events per 1,000 incarcerated persons per year) of AMI, CHFe, or stroke in people who are incarcerated. Similarly, we did not identify any empirical studies that systematically described the treatment of AMI, CHFe, or stroke in this population. We outline a series of research studies that should be conducted to inform future interventions and guide quality improvement efforts.

Quantifying cardiovascular disease risk and heart age predictions for men in the prison environment

OBJECTIVES

Cardiovascular disease (CVD) and associated risk factors within the prison population often present at a younger age in this cohort. Given CVD is largely preventable, it warrants investigation to fully quantify this risk. This study explored the relative predicted 10-year CVD risk and examined the calculated heart age in a representative sample of male individuals aged 25-84 years within the prison environment.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data were collected on 299 men who underwent a cardiometabolic risk assessment in HMP Parc, Bridgend. The QRISK2 algorithm was used to calculate 10-year CVD risk, relative risk (to general population) and the predicted heart age of an individual. Between-group differences (prison population vs general community) in cardiovascular risk predictions (10-year CVD risk and heart age) were assessed.

RESULTS

We observed that at all age groups, the relative risk of predicted 10-year CVD scores in the prison population was double that of the community risk (2.1 ± 0.6), and this was most apparent in the oldest age group (≥50 years: 17.0% compared to 8.8%; P < 0.001). Overall, the heart age of the sample was 7.5 (6.7-8.2) years higher than their own chronological age, and this difference increased to above 9 years in those aged ≥40 years.

CONCLUSIONS

This study provides quantifiable evidence to the elevated CVD risk in prison. Heart age predictions were almost a decade higher in those aged ≥40 years. Lowering the screening age for CVD by around 5 years in the prison population should be considered.

Evaluating the impact of a prison smoking ban on the cardiovascular health of men in a UK prison

PURPOSE

Smoking rates are known to be higher amongst those committed to prison than the general population. Those in prison suffer from high rates of comorbidities that are likely to increase their risk of cardiovascular disease (CVD), making it more difficult to manage. In 2016, a tobacco ban began to be implemented across prisons in England and Wales, UK. This study aims to measure the effect of the tobacco ban on predicted cardiovascular risk for those quitting smoking on admission to prison.

DESIGN/METHODOLOGY/APPROACH

Using data from a prevalence study of CVD in prisons, the authors have assessed the effect of the tobacco ban on cardiovascular risk, using predicted age to CVD event, ten-year CVD risk and heart age, for those who previously smoked and gave up on admission to prison.

FINDINGS

The results demonstrate measurable health gains across all age groups with the greatest gains found in those aged 50 years and older and who had been heavy smokers. Quitting smoking on admission to prison led to a reduced heart age of between two and seven years for all participants.

ORIGINALITY/VALUE

The data supports tobacco bans in prisons as a public health measure to reduce risk of CVD. Interventions are needed to encourage maintenance of smoking cessation on release from prison for the full health benefits to be realised.

SARS-CoV2 Infection and Comorbidity in Inmates: A Study of Central Italy

BACKGROUND AND OBJECTIVE

The presence of multiple chronic diseases is associated with an increase in mortality when related to COVID-19 infection.

THE AIMS OF OUR STUDY WERE

(i) to evaluate the association between the severity of the COVID-19 disease, defined as symptomatic hospitalized in prison or symptomatic hospitalized out of prison, and the presence of one or more comorbidities in two prisons in central Italy: L'Aquila and Sulmona; (ii) to describe the profiles of inmates using multiple correspondence analysis (MCA).

METHODS

A database was created including age, gender and clinical variables. The database containing anonymized data was password-protected. The Kruskal-Wallis test was used to evaluate a possible association between diseases and the severity of COVID-19 stratified by age groups. We used MCA to describe a possible characteristic profile of inmates.

RESULTS

Our results show that in the 25-50-year-old age group (COVID-19-negative) in the L'Aquila prison, 19/62 (30.65%) were without comorbidity, 17/62 (27.42%) had 1-2 comorbidities and only 3.23% had >2 diseases. It is interesting to note that in the elderly group, the frequency of 1-2 or >2 pathologies was higher than in the younger group, and only 3/51 (5.88%) inmates did not have comorbidities and were COVID-19 negative (p = 0.008). The MCA identified the following profiles: the prison of L'Aquila showed a group of women over 60 with diabetes, cardiovascular and orthopedic problems, and hospitalized for COVID-19; the Sulmona prison presented a group of males over 60 with diabetes, cardiovascular, respiratory, urological, gastrointestinal and orthopedic problems, and hospitalized or symptomatic due to COVID-19.

CONCLUSIONS

our study has demonstrated and confirmed that advanced age and the presence of concomitant pathologies have played a significant role in the severity of the disease: symptomatic hospitalized in the prison; symptomatic hospitalized out of the prison.

Estimating the burden of type 2 diabetes in the UK prison environment for the next decade

Although limited, global evidence suggests that the cardiometabolic health of those in prison is poorer than their community peers. Type 2 diabetes (T2DM) is a public health challenge and community rates are continuing to rise. Given that cardiometabolic risk factors are prevalent amongst younger individuals within the prison population, it is reasonable to assume that the prison environment will also experience an increase in new cases of T2DM. Therefore, the aim of this study was, to predict in a current prison population, how many potential new cases of T2DM could develop in the next 10 years. This study used health data collected from a prison sample (n = 299) aged 25-84 years in HMP Parc, UK, and the Diabetes UK Risk Score was used to predict T2DM risk. In terms of projecting new cases, it was estimated that in the next decade 6.4 individuals per 100 would develop T2DM, and this value increased to 16.4 individuals per 100 in those aged 50 years and older. The development of new cases across all age groups is a concern, and it appears that the prison community are a 'target population' for prevention opportunities.