To estimate the lifetime cardiovascular disease burden and costs associated with solitary confinement, we used public data from a 2015 lawsuit3 describing the prevalence of hypertension diagnoses among two groups of incarcerated men ages 27–45: those housed in one prison’s solitary confinement “supermax” units and those in the prison’s less-isolating maximum security units (Table 1). Those in solitary confinement received no group recreation or contact visits and few (if any) phone calls; those in maximum security received 2 h of daily group recreation, contact visits, and more calls. Individuals in solitary confinement scored an average of 54.9 on the UCLA Loneliness Scale (scale ranges 20–80, 80 is most lonely); those in maximum security averaged 41.6.3
Using the Cardiovascular Disease Policy Model, a computer simulation of cardiovascular disease in US adults,4 we estimated the lifetime incremental burden of disease, loss of quality-adjusted life years (QALYs), and medical costs associated with new diagnoses of hypertension at age 35. We assumed average systolic blood pressure distributions and control rates among hypertensive 35-year-olds based on the 2011–2014 National Health and Nutrition Examination Survey. Quality-of-life weights were based on observational data from the Global Burden of Disease study. Medical costs were estimated using California’s Office of Statewide Health Planning and Development, deflated using cost-to-charge ratios and the ratio of the US national average costs to California’s, and then inflated to 2017 dollars using the Consumer Price Index.