Cardiovascular Death and Access to Health Care Among Individuals Incarcerated in US State Prisons From 2001 to 2019

Incarcerated individuals have a disproportionate burden of cardiovascular risk factors. However, there is a paucity of data focusing on cardiovascular death and access to adequate health care among incarcerated individuals.

We used the Mortality in Correctional Institutions database from the US Bureau of Justice Statistics to examine cardiovascular deaths in all state prisons from 2001 to 2019, health care provision, as well as differences in these measures between racial and ethnic groups.

From 2001 to 2019, there were a total of 18 227 (28.0% of total) cardiovascular deaths among those incarcerated in state prisons. After declining from 2001, age-standardized cardiovascular mortality rates increased since 2012, and were 128.2 per 100 000 in 2019. Most cardiovascular deaths (40.8%) occurred after ≥120 months of incarceration, with 24.4% developing the condition that caused death after incarceration. Approximately 19% of individuals were not medically evaluated, 31% did not receive any diagnostic testing, and 27% did not receive medications during their incarceration for the cardiovascular condition causing death. Compared with White counterparts, Black individuals who died while incarcerated had a higher proportion of death related to a cardiovascular cause (30.9% versus 27.8%, P<0.001) and were less likely to be medically evaluated (78.6% versus 81.9%, P<0.0001) or receive treatment during incarceration for the cardiovascular condition determined to be the cause of death (68.1% versus 72.6%, P<0.0001).

Cardiovascular disease is an important cause of death among individuals incarcerated in state prisons. A large number of individuals who died from cardiovascular disease, did not receive medical treatment during their incarceration, with racial disparities in carceral care provision. Strategies to ensure quality and equitable cardiovascular care for this population are needed.