Abstract P160: Is Higher Educational Attainment or Higher Income Protective for Cardiovascular Risk in Deaf American Sign Language (ASL) Users?

Abstract

Background: Deaf ASL users appear to be burdened with higher cardiovascular risk due to communication barriers in the health care setting and from lack of accessible health educational and outreach programs. It is well known among the general population that higher educational attainment and income are highly correlated and provide cardiovascular protection. It is unknown if the same effect is seen among Deaf ASL users. Objective We sought to examine whether educational attainment and/or annual household income are inversely associated with cardiovascular risk in a sample of Deaf ASL users. Methods: The Deaf Health Survey (DHS) is an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) into sign language. A sample of 339 Deaf adults from the Rochester, New York MSA participated in the 2008 DHS and is included in the analysis. We assessed education (≤high school [low education], some college, and 4 year college degree or higher [referent]) and annual household income (<$25,000 versus ≥$25,000 [referent]). We constructed an aggregate (i.e. self-report of any of the four cardiovascular disease (CVD) equivalents: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) and conducted χ² tests of association for education and income. After excluding for any missing data on key variables, we conducted multi-logistic regression adjusting for : age, sex, race/ethnicity, and smoking. Results: In the study sample, 17.6% had ≤ high school education while 36.1% earned <$25,000; income and education were poorly correlated (r= 0.355). Among this sample (mean age= 46.4, range= 18-88), the prevalence of outcomes was: diabetes (9.4%), MI (5.0%), CVA (0.9%), and angina (4.5%). Unadjusted, low education was significantly associated with reporting an aggregate outcome (χ² =15.6; p=0.0004) whereas income was not (χ² =0.79; p=0.37). Low education continued to be significantly associated with increased likelihood of reporting an aggregate outcome (OR 5.057; 95% CI 1.73-14.82) whereas income was not significantly associated with reporting an aggregate outcome (OR 0.91; 95% CI: 0.39-2.12) even after adjustment. Conclusion: This is the first known study documenting that low educational attainment is associated with higher likelihood of reported cardiovascular disease among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect, unlike in the general population. This may be partially explained by the poor correlation between educational attainment and income in the study sample. Effective and accessible health communication and education with Deaf individuals with lower educational attainment could be addressed by the use of language-concordant providers and interpreters and following principles of clear communication (e.g. teach-back) to address ongoing cardiovascular health disparities.