Antiphospholipid Syndrome and Ischemic Stroke: Racial and Socioeconomic Disparities in Mortality, Hospitalization, and Healthcare Costs
AlDana Al-Khalaf1, Haya Al-Kuwari1, Salman Al Jerdi1, Soha Dargham1
1Weill Cornell Medicine - Qatar
Objective:
This study aimed to assess the impact of antiphospholipid syndrome (APLS) on in-hospital outcomes among ischemic stroke patients whose stroke was not directly attributed to APLS, and to examine variations across racial and socioeconomic groups.
Background:
APLS is an autoimmune prothrombotic disorder associated with ischemic stroke. However, its effects on outcomes across different stroke subtypes and demographic groups remains underexplored.
Design/Methods:
A retrospective cross-sectional analysis was conducted using the National Inpatient Sample (2016–2021). Adult patients (≥18 years) with ischemic stroke were identified by ICD-10 codes and categorized into cardioembolic, large vessel disease (LVD), and small vessel disease (SVD) subtypes. APLS was defined using ICD-10 coding. Outcomes included in-hospital mortality, discharge disposition, length of stay (LOS), and total hospital charges. Multivariable regression models adjusted for age, sex, income, and comorbidities such as diabetes, hypertension, and atrial fibrillation.
Results:
Among 578,696 ischemic stroke admissions, 4,390 (0.8%) had APLS. Compared with non-APLS patients, those with APLS had higher mortality (7.0% vs 4.2%; aOR 1.65, 95% CI 1.47–1.86, p < 0.001), greater transfer discharge rates (65% vs 61.3%; aOR 1.23, 95% CI 1.15–1.32, p < 0.001), longer LOS (mean 7.3 vs 5.1 days; p < 0.001), and higher total hospital charges (mean $107,706 vs $71,487; p < 0.001). When stratified by race, Black patients had the longest stays (9.8 days), while White (6.6 days) and Native American (6.1 days) patients had the shortest (p < 0.001). Hispanic and “Other” racial groups incurred the highest total charges ($144,269 and $162,120; p < 0.001). Socioeconomic stratification similarly revealed significant disparities in LOS and hospital costs.
Conclusions:
APLS was associated with higher mortality, prolonged hospitalization, and increased healthcare costs in ischemic stroke. Racial and socioeconomic disparities amplified these outcomes, underscoring the need for equitable recognition and tailored management of APLS-related stroke.
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