Abstract MP06: Cardiovascular Disease in Community-Dwelling US Adults Involved With the Criminal Justice System: A Simulation Analysis

Introduction: Approximately 4.4 million US adults live in the community while on probation or parole. They have disproportionately elevated cardiovascular risk factors, morbidity and mortality, along with limited access to healthcare. However, the long-term burden of cardiovascular disease (CVD) in this population is uncertain. We developed a simulation model to quantify cardiovascular risk and adverse events in community-dwelling US adults involved with the criminal justice system, leveraging all known sources of data on this under-studied, high-risk population. Methods: We adapted the CVD Policy Model, a validated state-transition simulation model of CVD in all US adults, using input data specific to 25-54 year-old individuals on probation or parole in 2018. Population size was defined using estimates from the Bureau of Justice Statistics. CVD risk factor burden was approximated by re-weighting data from the National Health and Nutrition Examination Survey years 2005 to 2018 to match demographic, socioeconomic, and health variables among individuals reporting past-year probation or parole in the National Survey on Drug Use and Health. CVD incidence and mortality rates were calibrated to outcomes in cohort studies and vital statistics data. Outcomes were myocardial infarction (MI), stroke, and death over a 10-year horizon (2018-2027) and were compared with projections for an age- and gender-matched cohort of adults in the general US population. We also examined projected reductions in CVD outcomes over 10 years that could be expected if risk factor distributions in the probation/parole population were similar to distributions observed for the general US population. Results: The simulated cohort consisted of 2.9 million adults 25-54 years of age on probation or parole in 2018; 71% were men, 30% were living below the poverty line, and 57% had no regular access to healthcare. An estimated 61% were current smokers, 29% had BP ≥130/80 mmHg, and 8% had diabetes. The study cohort was projected to experience between 36,400 and 69,600 incident MIs and between 22,400 and 37,500 incident strokes over 10 years. This would be 1.4-2.6 times the CVD incidence in age- and gender-matched adults in the general US population. Lowering rates of active smoking in those on probation or parole to rates observed for the general US population (i.e., from 61% to 21%) would reduce MI and stroke events by 16,400 to 29,100 over 10 years, a 27% reduction from current projections. Discussion: We developed and calibrated a computer simulation model to quantify the burden of CVD in community-dwelling US adults followed by the US justice system. We project that adults on probation or parole have higher CVD risk than the general US population. Future work will leverage this platform to estimate the impact of clinical, community, and policy interventions to reduce CVD burden in this vulnerable population.