@Rick, I didn't specifically look at doctype, but Steve Faulkner did in his original article (see the link at the top of this post). He found that 101 of the 130 pages containing role="main" (78%) used the HTML5 doctype, which of course leaves 22% that didn't. I do recommend using ARIA even if using an earlier doctype. Validation is important, but if validation and accessibility conflict, I think most would agree accessibility should trump validation. Assistive technologies that support ARIA landmarks do so regardless of doctype, and otherwise the presence of these role attributes has no ill effects in any user agent.
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The U.S. Department of Health and Human Services (HHS) also enforces Title II of the ADA relating to access to programs, services and activities receiving HHS federal financial assistance. This includes ensuring that people who are deaf or hard-of-hearing have access to sign language interpreters and other auxiliary aids in hospitals and clinics when needed for effective communication.
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The Americans with Disabilities Act (ADA) was first passed in 1990. Twenty years later, the US Department of Justice released an update called the 2010 ADA Standards for Accessible Design. These standards cover the design of physical spaces and have been interpreted to include web locations as well, so it can be difficult for the would-be accessible website designer to use them.