Disparities in Stroke Care for Deaf American Sign Language Users: A Comparative Study
Marcus Milani1, Erjia Cui2, Annette Xenopoulos-Oddsson3, Solmaz Ramezani Hashtjin4, Haitham Hussein1, Christopher Streib5, Margy McCullough-Hicks6
1University of Minnesota Medical School, 2Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, 3University of Minnesota, Masonic Institute for the Developing Brain, 4University of Nebraska Medical Center, University of Nebraska Medical Center, 5Department of Neurology, 6University of Minnesota Department of Neurology
Objective:
Investigate disparities in stroke care among Deaf ASL users.
Background:
An estimated 500,000 culturally Deaf signers in the U.S. face healthcare disparities, yet research on ischemic stroke outcomes in this population is lacking. Our scoping review identified critical gaps in stroke symptom recognition and higher rates of stroke risk factors in Deaf individuals. Similar disparities are seen in other minority populations, like the Hmong, an underrepresented group within our hospital system. This study aims to determine if Deaf patients have worse stroke outcomes than their English-speaking and Hmong-speaking peers.
Design/Methods:
We compared outcomes of Deaf American Sign Language (ASL) users (n=21) with matched English (n=210), and Hmong (n=21) speakers between 2/2015 to 2/2025. Cases were matched by stroke type (acute ischemic stroke [AIS] or transient ischemic attack [TIA]), age, and gender. Data was manually extracted from electronic medical records. Statistical analysis used Pearson’s Chi-squared and Fisher’s exact tests for categorical outcomes or Kruskal-Wallis rank sum test for the continuous outcome.
Results:
The ASL group had significantly higher baseline comorbidity rates. The median time from emergency room arrival to brain imaging was 119.50 minutes (49.00–924.00) for the ASL group, which was significantly longer (p=0.008) than for the Hmong (35.00 mins; 14.00–78.00) and English-speaking groups (81.00 mins; 24.00–183.00). No significant differences were observed in stroke etiology, baseline NIH Stroke Scale scores, time from last known well to ER arrival, or the proportion of stroke code activations.
Conclusions:
This study reveals that Deaf ASL users with ischemic stroke experience higher rates of comorbid conditions and delays in diagnostic imaging compared to English and Hmong speaking patients. Our study was limited by small sample size. Further research of stroke care in the Deaf community is needed to confirm our findings.
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