title: Higher educational attainment but not higher income is protective for cardiovascular risk in Deaf American Sign Language (ASL) users.
abstract: BACKGROUND
  Higher educational attainment and income provide cardiovascular protection in the general population. It is unknown if the same effect is seen among Deaf American Sign Language (ASL) users who face communication barriers in health care settings.
  
  
  OBJECTIVE
  We sought to examine whether educational attainment and/or annual household income were inversely associated with cardiovascular risk in a sample of Deaf ASL users.
  
  
  METHODS
  This cross-sectional study included 302 Deaf respondents aged 18-88 years from the Deaf Health Survey (2008), an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) administered in sign language. Associations between the self-reported cardiovascular disease equivalents (CVDE; any of the following: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) with educational attainment (≤high school [low education], some college, and ≥4 year college degree [referent]), and annual household income (<$25,000, $25,000-<$50,000, or ≥$50,000 [referent]) were assessed using a multivariate logistic regression adjusting for age, sex, race/ethnicity, and smoking history.
  
  
  RESULTS
  Deaf respondents who reported ≤high school education were more likely to report the presence of a CVDE (OR = 5.76; 95% CI = 2.04-16.31) compared to Deaf respondents who reported having ≥4 year college degree after adjustment. However, low-income Deaf individuals (i.e., household incomes <$25,000) were not more likely to report the presence of a CVDE (OR = 2.24; 95% CI = 0.76-6.68) compared to high-income Deaf respondents after adjustment.
  
  
  CONCLUSIONS
  Low educational attainment was associated with higher likelihood of reported cardiovascular equivalents among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect for Deaf respondents.
authors.affiliation: Family Medicine Research Programs, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; National Center for Deaf Health Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: michael_mckee@urmc.rochester.edu.
authors.forename: Michael M
authors.initials: MM
authors.lastname: McKee
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: McKee
authors.affiliation: Family Medicine Research Programs, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Winters
authors.affiliation: National Center for Deaf Health Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Sutter
authors.affiliation: National Center for Deaf Health Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pearson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040343:Behavioral Risk Factor Surveillance System; D002318:Cardiovascular Diseases / Q000209:etiology*; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019986:Persons with Hearing Disabilities; D011203:Poverty; D012307:Risk Factors; D012574:Schools; D012813:Sign Language; D014495:Universities
keywords: Cardiovascular health; Deaf; Education; Health disparities; Income