{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:27:49Z","timestamp":1769171269718,"version":"3.49.0"},"reference-count":108,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,20]]},"abstract":"<jats:sec id=\"jah310947-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Few studies assess the association between county\u2010level incarceration rates and stroke death, and none test mechanisms. We examine the link between county imprisonment rates and stroke death, testing pathways and identifying racial disparities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310947-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">In a cross\u2010sectional design, we regressed stroke death onto imprisonment rates, adjusting for poverty, racial composition, education, unemployment, insurance, and violent crime. Using bootstrap methodology, we tested mediation through sports\/recreational facilities and food environment, mental health provider and primary care physician (PCP) access, and community mental distress. Data spanned 4\u2009years (2016\u20132019) and included 2260 counties.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310947-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Adjusted models indicated a 0.08 (95% CI, 0.05\u20130.10) increase in stroke deaths for every 1\u2010unit change in imprisonment rate. This association was mediated by food environment (indirect effect, 0.006 [95% CI, 0.000\u20130.014]), primary care physician access (indirect effect, 0.002 [95% CI, 0.000\u20130.006]), and mental distress (indirect effect, 0.014 [95% CI, 0.007\u20130.022]). Counties in the top versus bottom quintile of imprisonment rates had 86.26% larger Black populations and 23.46% smaller White populations. Counties in the top versus bottom quintile of stroke death had 88.94% larger Black populations and 16.19% smaller White populations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310947-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Our results complement evidence that living in high\u2010jail\u2010incarceration counties contributes to stroke death and associated racial disparities. We provide new evidence on prison incarceration rates and the pathways underpinning this association. County\u2010level imprisonment rates and the identified mechanisms represent avenues for further research into how stroke death and disparities may be mitigated.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.039065","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T09:46:29Z","timestamp":1747129589000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["County Incarceration Rate and Stroke Death: A Cross\u2010Sectional Study of the Influence of Physical Environment, Health\u00a0Care Access, and Community Mental Distress"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6627-3322","authenticated-orcid":false,"given":"Anders","family":"Larrabee Sonderlund","sequence":"first","affiliation":[{"name":"Institute for Excellence in Health Equity, NYU Grossman School of Medicine","place":["New York, USA"]},{"name":"University of Southern Denmark","place":["Odense, Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1403-6891","authenticated-orcid":false,"given":"Emily A.","family":"Wang","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Yale University","place":["New Haven, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Institute for Excellence in Health Equity, NYU Grossman School of Medicine","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol R.","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Institute for Health Equity Research, Icahn School of Medicine, Mount Sinai","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4905-5136","authenticated-orcid":false,"given":"Antoinette","family":"Schoenthaler","sequence":"additional","affiliation":[{"name":"Institute for Excellence in Health Equity, NYU Grossman School of Medicine","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-6501","authenticated-orcid":false,"given":"Louisa W.","family":"Holaday","sequence":"additional","affiliation":[{"name":"Institute for Health Equity Research, Icahn School of Medicine, Mount Sinai","place":["New York, USA"]},{"name":"Icahn School of Medicine at Mount Sinai","place":["New York, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001209"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052"},{"key":"e_1_3_1_4_2","unstructured":"[database online] . 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