Abstract 4368520: Socioeconomic Disparities in Acute Ischemic Stroke Care Among Atrial Fibrillation Patients

Abstract

Background: Atrial fibrillation (AF) is a common comorbidity in the U.S. and significantly contributes to the incidence of acute ischemic strokes. This study examines the impact of household income on management and outcomes of Acute ischemic stroke in patients with AF. Research: Question: How does socioeconomic status impact the management and outcomes of Acute ischemic stroke in patients with AF? Methods: We used data from the National Inpatient Sample database (2018-2020), analyzing adult hospitalizations with primary diagnosis of acute ischemic stroke and secondary diagnosis of AF. Patients were grouped into four income quartiles: Q1 ($1 - $51,999), Q2 ($52,000 - $65,999), Q3 ($66,000 - $87,999), and Q4 ($88,000+). Outcomes included in-hospital mortality, utilization of endovascular thrombectomy (EVT), length of stay (LOS), inflation-adjusted total charge (IATC), intracranial hemorrhage (ICH) and sepsis. Multivariable logistic and linear regression analyses were performed, for demographic, clinical, and hospital factors. Results: A total of 340,835 hospitalizations with Acute ischemic stroke and AF were identified. Mean age was 77 years (11), and 52% were female. When comparing highest income quartile to lowest, admissions in the highest income quartile had significantly lower in-hospital mortality rates (6.5% vs. 7.0%; p < 0.001), lower sepsis rates (2.7% vs. 3.3%; p = 0.032), shorter mean LOS (6.2 vs. 7.7 days; p < 0.001), and higher mean IATC ($116,076 vs. $107,568; p = 0.06). Hospitalizations in highest income quartile had higher rates of ICH (9.4% vs. 9.1%; p = 0.11) and EVT (6.8% vs. 6.1%; p = 0.7), but these differences were not statistically significant. After adjusting for confounders, higher income stayed markedly associated with lower in-hospital mortality (adjusted odds ratio [aOR]: 0.78, 95% CI: 0.70–0.86; p < 0.001), lower sepsis rates (aOR: 0.85, 95% CI: 0.74–0.99; p = 0.032), shorter LOS (aOR: -0.28, 95% CI: -0.43 to -0.14; p < 0.001), and higher IATC (aOR: 2,403, 95% CI: -4,911 to 105; p = 0.06). There were no significant differences observed in ICH (aOR: 0.95, 95% CI: 0.87–1.03; p = 0.02) and EVT (aOR: 1.06, 95% CI: 0.95–1.19; p = 0.3) between highest and lowest income quartiles. Conclusion: Higher socioeconomic status is associated with lower in-hospital mortality and sepsis rates, shorter LOS, and higher IATC. These disparities suggest the need for targeted interventions to address socioeconomic inequalities and improve stroke care.