Higher educational attainment but not higher income is protective for cardiovascular risk in Deaf American Sign Language (ASL) users

Michael M. McKee, M.D., M.P.H., Kimberly McKee, M.P.H., Paul Winters, M.S., Erika Sutter, M.P.H., Thomas Pearson, M.D., M.P.H., Ph.D.

Disability and Health Journal, Vol. 7, Issue 1, p49–55
Published online: August 29, 2013
DOI: http://dx.doi.org/10.1016/j.dhjo.2013.07.001


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.


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.


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.


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.


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.