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Obi ON, Alqalyoobi S, Maddipati V, Lower EE, Baughman RP. High-Resolution CT Scan Fibrotic Patterns in Stage IV Pulmonary Sarcoidosis: Impact on Pulmonary Function and Survival. Chest 2024; 165:892-907. [PMID: 37879560 DOI: 10.1016/j.chest.2023.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Different patterns of fibrosis on high-resolution CT scans (HRCT) have been associated with reduced survival in some interstitial lung diseases. Nothing is known about HRCT scan patterns and survival in sarcoidosis. RESEARCH QUESTION Will a detailed description of the extent and pattern of HRCT scan fibrosis in patients with stage IV pulmonary sarcoidosis impact pulmonary function and survival? STUDY DESIGN AND METHODS Two hundred forty patients with stage IV sarcoidosis at two large tertiary institutions were studied. The earliest HRCT scan with fibrosis was reviewed for extent of fibrosis (< 10%, 10%-20%, and > 20%) and presence of bronchiectasis, upper lobe fibrocystic changes, basal subpleural honeycombing, ground-glass opacities (GGOs), large bullae, and mycetomas. Presence of sarcoidosis-associated pulmonary hypertension (SAPH) and pulmonary function testing performed within 1 year of HRCT were recorded. Patients were followed up until last clinic visit, death, or lung transplantation. RESULTS The mean age was 58.4 years. Seventy-four percent were Black, 63% were female, and mean follow-up was 7.4 years. Death or LT occurred in 53 patients (22%). Thirty-one percent had > 20% fibrosis, 25% had 10%-20% fibrosis, and 44% had < 10% fibrosis. The most common HRCT abnormalities were bronchiectasis (76%), upper lobe fibrocystic changes (36%), and GGOs (28%). Twelve percent had basal subpleural honeycombing, and 32% had SAPH. Patients with > 20% fibrosis had more severe pulmonary impairment, were more likely to have SAPH (53%), and had worse survival (44% mortality; P < .001). Upper lobe fibrocystic changes, basal subpleural honeycombing, and large bullae were associated with worse pulmonary function and worse survival. Patients with basal subpleural honeycombing had the worst pulmonary function and survival (55% mortality; P < .001). GGOs were associated with worse pulmonary function but not worse survival, and mycetomas were associated with worse survival but not worse pulmonary function. A Cox proportional hazards model indicated that basal subpleural honeycombing (hazard ratio, 7.95), diffusion capacity for carbon monoxide < 40% (HR, 5.67) and White race (hazard ratio, 2.61) were independent predictors of reduced survival. INTERPRETATION HRCT scan features of fibrotic pulmonary sarcoidosis had an impact on pulmonary function and survival. Presence of >20% fibrosis and basal subpleural honeycombing are predictive of worse pulmonary function and worse survival in patients with stage IV pulmonary sarcoidosis.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
| | - Shehabaldin Alqalyoobi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC; Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Veeranna Maddipati
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati, Cincinnati, OH
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Kırkıl G. Predictors of Mortality in Sarcoidosis. Clin Chest Med 2024; 45:175-183. [PMID: 38245365 DOI: 10.1016/j.ccm.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a systemic granulomatous disorder that affects individuals of all racial/ethnic origins and occurs at any time of life. Spontaneous remission is frequent and may occur in 2 of 3 patients, while the remaining cases have chronic, progressive disease, with some patients presenting with organ- and life-threatening involvements. Many reports have investigated which features may be related to poor outcomes in patients with sarcoidosis. Pulmonary hypertension and respiratory failure from pulmonary fibrosis are the most common complications associated with the cause of death in sarcoidosis. Other major causes of death include cardiac, neurologic, hepatic involvement, and hemoptysis from aspergilloma.
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Affiliation(s)
- Gamze Kırkıl
- Medicine Faculty, Department of Chest Disease, Firat University, Elazig 23200, Turkey.
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3
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Levin AM, She R, Chen Y, Adrianto I, Datta I, Loveless IM, Garman L, Montgomery CG, Li J, Iannuzzi MC, Rybicki BA. Identification of Environmental Exposures Associated with Risk of Sarcoidosis in African Americans. Ann Am Thorac Soc 2023; 20:1274-1282. [PMID: 37209419 PMCID: PMC10502890 DOI: 10.1513/annalsats.202208-722oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/19/2023] [Indexed: 05/22/2023] Open
Abstract
Rationale: Sarcoidosis is a racially disparate granulomatous disease likely caused by environmental exposures, genes, and their interactions. Despite increased risk in African Americans, few environmental risk factor studies in this susceptible population exist. Objectives: To identify environmental exposures associated with the risk of sarcoidosis in African Americans and those that differ in effect by self-identified race and genetic ancestry. Methods: The study sample comprised 2,096 African Americans (1,205 with and 891 without sarcoidosis) compiled from three component studies. Unsupervised clustering and multiple correspondence analyses were used to identify underlying clusters of environmental exposures. Mixed-effects logistic regression was used to evaluate the association of these exposure clusters and the 51 single-component exposures with risk of sarcoidosis. A comparison case-control sample of 762 European Americans (388 with and 374 without sarcoidosis) was used to assess heterogeneity in exposure risk by race. Results: Seven exposure clusters were identified, five of which were associated with risk. The exposure cluster with the strongest risk association was composed of metals (P < 0.001), and within this cluster, exposure to aluminum had the highest risk (odds ratio, 3.30; 95% confidence interval [95% CI], 2.23-4.09; P < 0.001). This effect also differed by race (P < 0.001), with European Americans having no significant association with exposure (odds ratio, 0.86; 95% CI, 0.56-1.33). Within African Americans, the increased risk was dependent on genetic African ancestry (P = 0.047). Conclusions: Our findings support African Americans having sarcoidosis environmental exposure risk profiles that differ from those of European Americans. These differences may underlie racially disparate incidence rates that are partially explained by genetic variation differing by African ancestry.
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Affiliation(s)
- Albert M. Levin
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Ruicong She
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Yalei Chen
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Indra Adrianto
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Indrani Datta
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Ian M. Loveless
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Lori Garman
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; and
| | - Courtney G. Montgomery
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; and
| | - Jia Li
- Department of Public Health Science and
- Center for Bioinformatics, Henry Ford Health System, Detroit, Michigan
| | - Michael C. Iannuzzi
- Department of Medical Education, School of Medicine, City University of New York, New York, New York
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Abstract
Interstitial lung disease (ILD), a clinically recognized group of diseases resulting in pulmonary fibrosis, affects up to 200 individuals per 100,000 in the United States. Sarcoidosis has a wide range of clinical manifestations including pulmonary fibrosis. Health disparities are prevalent in both ILD and sarcoidosis around socioeconomic status, race, gender, and geographic location. This review outlines the known health disparities, discusses possible determinants of disparities, and outlines a path to achieve equity in ILD and sarcoidosis.
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Affiliation(s)
- Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Ali M Mustafa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Naima Farah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, University of Virginia Pulmonary & Critical Care, 1215 Lee Street, 2nd Floor, Charlottesville, VA 22903, USA
| | - Catherine A Bonham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, University of Virginia Pulmonary & Critical Care, 1215 Lee Street, 2nd Floor, Charlottesville, VA 22903, USA
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5
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Ezeh N, Caplan A, Rosenbach M, Imadojemu S. Cutaneous Sarcoidosis. Dermatol Clin 2023; 41:455-470. [DOI: 10.1016/j.det.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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6
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Sodhi A, Cox-Flaherty K, Greer MK, Lat TI, Gao Y, Polineni D, Pisani MA, Bourjeily G, Glassberg MK, D'Ambrosio C. Sex and Gender in Lung Diseases and Sleep Disorders: A State-of-the-Art Review: Part 2. Chest 2023; 163:366-382. [PMID: 36183784 PMCID: PMC10083131 DOI: 10.1016/j.chest.2022.08.2240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
There is now ample evidence that differences in sex and gender contribute to the incidence, susceptibility, presentation, diagnosis, and clinical course of many lung diseases. Some conditions are more prevalent in women, such as pulmonary arterial hypertension and sarcoidosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as the higher number of exacerbations experienced by women with cystic fibrosis (CF), more fatigue in women with sarcoidosis, and more difficulty in achieving smoking cessation. Outcomes such as mortality may be different as well, as indicated by the higher mortality in women with CF. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors are often not adequately addressed in clinical trials. Various aspects of lung/sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for all patients. This article is the second part of a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of selected lung diseases. We review the more recent literature and focus on guidelines incorporating sex and gender differences in pulmonary hypertension, CF and non-CF bronchiectasis, sarcoidosis, restless legs syndrome and insomnia, and critical illness. We also provide a summary of the effects of pregnancy on lung diseases and discuss the impact of sex and gender on tobacco use and treatment of nicotine use disorder.
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Affiliation(s)
- Amik Sodhi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Katherine Cox-Flaherty
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Meredith Kendall Greer
- Division of Pulmonary, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Tasnim I Lat
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Health, Temple, TX
| | - Yuqing Gao
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Deepika Polineni
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO
| | - Margaret A Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Ghada Bourjeily
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Carolyn D'Ambrosio
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
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Association of County-degree Social Vulnerability with Chronic Respiratory Disease Mortality in the United States. Ann Am Thorac Soc 2023; 20:47-57. [PMID: 36044720 DOI: 10.1513/annalsats.202202-136oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Rationale: Chronic respiratory diseases, the third leading cause of death worldwide, have been associated with significant morbidity, mortality, and increased economic burden that make a profound impact on individuals and communities. However, limited research has delineated complex relationships between specific sociodemographic disparities and chronic respiratory disease outcomes among U.S. counties. Objectives: To assess the association of county-level sociodemographic vulnerabilities with chronic respiratory disease mortality in the United States. Methods: Chronic respiratory disease mortality data among U.S. counties for 2014-2018 was obtained from the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) database. The social vulnerability index (SVI), including subindices of socioeconomic status, household composition and disability, minority status and language, and housing type and transportation, is a composite, percentile-based measure developed by the CDC to evaluate county-level sociodemographic vulnerabilities to disasters. We examined county-level sociodemographic characteristics from the SVI and classified the percentile rank into quartiles, with a higher quartile indicating greater vulnerability. The associations between chronic respiratory disease mortality and overall SVI, its four subindices, and each county characteristic were analyzed by negative binomial regression. Results: From 2014 to 2018, the age-adjusted mortality per 1,000,000 population attributed to chronic lower respiratory disease was 406.4 (95% confidence interval [CI], 405.5-407.3); chronic obstructive pulmonary disease (COPD), 393.7 (392.8-394.6); asthma, 10.0 (9.9-10.2); interstitial lung disease (ILD), 50.5 (50.1-50.8); idiopathic pulmonary fibrosis (IPF), 37.0 (36.7-37.3); and sarcoidosis, 5.3 (5.2-5.4). Counties in the higher quartile of overall SVI were significantly associated with greater disease mortality (chronic lower respiratory disease, incidence rate ratios: fourth vs. first quartile, 1.43 [95% CI, 1.39-1.48]; COPD, 1.44 [1.39-1.49]; asthma, 2.06 [1.71-2.48]; ILD, 1.07 [1.02-1.13]; IPF, 1.14 [1.06-1.22]; sarcoidosis, 2.01 [1.44-2.81]). In addition, higher mortality was also found in counties in the higher quartile of each subindex and most sociodemographic characteristics. Conclusions: Chronic respiratory disease mortalities were significantly associated with county-level sociodemographic determinants as measured by the SVI in the United States. These findings suggested sociodemographic determinants may add a considerable barrier to establishing health equity. Multidegree public health strategies and clinical interventions addressing inequitable outcomes of chronic respiratory disease should be developed and targeted in areas with greater social vulnerability and disadvantage.
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Choi JY, Lee JH, Seo JM, Yun SY, Koo HYR, Yu DS, Lee YB. Incidence and death rate of sarcoidosis in Korea in association with metabolic diseases. J Dermatol 2022; 49:488-495. [PMID: 35040161 DOI: 10.1111/1346-8138.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease that affects a variety of organs. Although the etiology has not been fully understood, it is thought that diverse genetic and environmental factors interact with the immune system to develop granulomas. The incidence and death rate of sarcoidosis vary according to race. This study was conducted to identify the epidemiology of sarcoidosis in Korea and reveal its association with comorbid diseases such as diabetes mellitus, hypertension, and dyslipidemia in a population-based database. We retrospectively analyzed Korean National Health Insurance claims data between 2006 and 2017. The average annual incidence from 2006 to 2017 was 0.82/100 000 person-years and the all-cause death rate in sarcoidosis patients was 9.25/1000 cases. The incidence of sarcoidosis was higher in patients with diabetes mellitus, hypertension, and dyslipidemia than patients without those underlying diseases. Sarcoidosis patients with diabetes mellitus and hypertension showed an increased death rate after adjusting the confounding factors (hazard ratio [95% confidence interval], 1.66 [1.23-2.23] and 1.73 [1.29-2.31] respectively), however, patients with dyslipidemia showed a low death rate (HR = 0.64 [0.46-0.88]). In conclusion, we found that sarcoidosis is associated with diabetes mellitus, hypertension, and dyslipidemia and that diabetes mellitus and hypertension increase the risk of death in sarcoidosis patients. Extra caution is needed in sarcoidosis patients who already have these metabolic diseases.
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Affiliation(s)
- Jin Young Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Joo Hee Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ji Min Seo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - So Yeon Yun
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ha Yeh Rin Koo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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9
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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Innabi A, Alzghoul BN, Kalra S, Al-Hakim T, Buchanan M, Shivas T, Xue W, Gomez-Manjarres D, Patel DC. Sarcoidosis among US Hispanics in a Nationwide Registry. Respir Med 2021; 190:106682. [PMID: 34788736 DOI: 10.1016/j.rmed.2021.106682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sarcoidosis has been well studied in multiple races and ethnic groups. However, there is a paucity of data that describes sarcoidosis in Hispanics. We aimed to determine the prevalence of Hispanic ethnicity, clinical characteristics and impact of sarcoidosis among Hispanics from a US based national registry. METHODS We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures questionnaire. This registry is a web-based, self-reported questionnaire that provides data related to demographics, diagnostics, organ involvement, treatment modalities, and the physical and psychosocial impact of sarcoidosis. We compared Hispanic patients to non-Hispanics. We performed multivariate logistic regression analysis adjusting for age, gender, education, income and insurance status and looked at the association between Hispanic ethnicity with depression, chronic pain syndrome, chronic fatigue syndrome, impact on family finances, employment-based disability and job termination. RESULTS Nine percent of the patients reported a Hispanic ethnicity and the majority of these patients self-identified as white women. The most common organs involved were the lungs (74.9%), central lymph nodes (53.8%), and peripheral lymph nodes (37.1%). Hispanics reported more peripheral nerves and peripheral lymph nodes involvement than non-Hispanics. Hispanics experienced more depression, sleep apnea, and chronic pain syndrome than non-Hispanics. The use of mobility assistive devices was more common among Hispanics, as well as employment-based disability, and disease-related job termination compared to non-Hispanics. The majority of Hispanics reported significantly more pain that interfered with the enjoyment of life than non-Hispanics. On multivariate logistic regression analysis, Hispanic ethnicity was associated with depression (adjusted odds ratio (aOR) = 1.5; 95% CI: 1.01-2.2), chronic pain syndrome (aOR = 1.7; 1.1-2.6), job termination due to sarcoidosis (aOR = 1.7; 1.1-2.7) and higher impact on family finances (aOR = 1.7; 1.1-2.5). CONCLUSION The clinical presentation of sarcoidosis in Hispanic patients differs from that in non-Hispanic patients living in the United States. These differences should be considered when managing Hispanic patients with sarcoidosis. We encourage more studies that investigate phenotyping among Hispanics with sarcoidosis.
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Affiliation(s)
- Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Saminder Kalra
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | | | - Mindy Buchanan
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Tricha Shivas
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine; University of Florida; Gainesville, FL, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Divya C Patel
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA.
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Abstract
PURPOSE OF REVIEW The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. RECENT FINDINGS Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and females. Worse dyspnea, lower health-related quality of life, and higher rates of mortality and hospitalization are more common among those who are Black, female, or of low socioeconomic status. SUMMARY Health disparities in sarcoidosis by socioeconomic status, race, and gender have been described for decades. In this review, we describe potential contributors to health disparities including stress and propose interventions to address disparities including creating educational programs accessible for low-income patients and caregivers, targeting medication adherence and trust in physicians and the medical system, and ensuring access to high-quality care for all patients. As clinicians and researchers, we owe it to our patients to not only describe the health disparities that exist but also stimulate to achieve improvement in sarcoidosis.
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12
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Sarcoidosis epidemiology: recent estimates of incidence, prevalence and risk factors. Curr Opin Pulm Med 2021; 26:527-534. [PMID: 32701677 DOI: 10.1097/mcp.0000000000000715] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the latest studies on sarcoidosis incidence, prevalence and risk factors with a special focus on reports in the last 2 years. The potential biases affecting these studies are discussed. RECENT FINDINGS The prevalence and incidence of sarcoidosis vary greatly depending on region of the world. Variations in data sources and settings can affect estimates of the burden of sarcoidosis, sometimes making them difficult to compare across countries. It is not well understood how the distribution of sarcoidosis phenotypes differs across populations. Age, sex and race are the most important sources of variation in incidence and prevalence. Recent epidemiological studies provide new insights on the role of genetic and nongenetic risk factors for sarcoidosis. SUMMARY High-quality and systematically collected data, with depth (detailed information per individual) and breadth (many individuals), is needed to further understand the complexity and heterogeneity of sarcoidosis.
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13
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State-Level Health Disparity Is Associated with Sarcoidosis Mortality. J Clin Med 2021; 10:jcm10112366. [PMID: 34072248 PMCID: PMC8199085 DOI: 10.3390/jcm10112366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sarcoidosis is associated with significant morbidity and rising health care utilization, which contribute to the health care burden and disease outcome. In the United States (US), evaluation of sarcoidosis mortality by individual states has not been investigated. METHODS We examined sarcoidosis mortality data for 1999-2018 from the Centers for Disease Control and Prevention (CDC). America's Health Rankings (AHR) assesses the nation's health on a state-by-state basis to determine state health rankings. The numbers of certified Sarcoidosis Clinics within the US were obtained from World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) and Foundation for Sarcoidosis Research (FSR). The associations between sarcoidosis mortality and state health disparities were calculated by linear regression analyses. RESULTS From 1999 to 2018, the mean age-adjusted mortality rate (AAMR) in all populations, African Americans and European Americans were 2.9, 14.8, and 1.4 per 1,000,000 population, respectively. South Carolina had the highest AAMR for all populations (6.6/1,000,000) and African Americans (20.8/1,000,000). Both Utah and Vermont had the highest AAMR for European Americans (2.6/1,000,000). New York State and South Atlantic had the largest numbers of FSR-WASOG Sarcoidosis Clinics (6 and 13, respectively). States with better health rankings were significantly associated with lower AAMR in all population (R2 = 0.170, p = 0.003) but with higher AAMR in European Americans (R2 = 0.223, p < 0.001). CONCLUSIONS There are significant variations in sarcoidosis mortality within the US. Sarcoidosis mortality was strongly associated with state health disparities. The current study suggests sarcoidosis mortality could be an indicator to reflect the state-level health care disparities in the US.
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14
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Sesé L, Khamis W, Jeny F, Uzunhan Y, Duchemann B, Valeyre D, Annesi-Maesano I, Nunes H. Adult interstitial lung diseases and their epidemiology. Presse Med 2020; 49:104023. [PMID: 32437842 DOI: 10.1016/j.lpm.2020.104023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Lucile Sesé
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France; Service de physiologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Warda Khamis
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Florence Jeny
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Yurdagul Uzunhan
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Boris Duchemann
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France
| | - Dominique Valeyre
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Isabella Annesi-Maesano
- Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Hilario Nunes
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France.
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