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.
Highlights
Sarcoidosis is a multisystem granulomatous disease of unknown origin that mainly affects lungs, lymph nodes, skin, and eyes [1]
From 1999 to 2018, a total of 50,567,774 deaths occurred in the United States (US), and sarcoidosis was documented as the underlying cause of death in 18,877 decedents
This study demonstrates geographic differences in sarcoidosis-related mortality in the US for 1999–2018, and to our knowledge, the first-ever assessment to evaluate the association between sarcoidosis-related age-adjusted mortality rate (AAMR) and state-level health disparities
Summary
Sarcoidosis is a multisystem granulomatous disease of unknown origin that mainly affects lungs, lymph nodes, skin, and eyes [1]. African Americans have a 3–5 fold greater incidence of sarcoidosis and a 10–12 fold greater mortality rate compare to European Americans [3,4]. Geographic variabilities of sarcoidosis-related mortality in the US have been documented with the highest rate in the southern region for all population, the Midwest for African Americans females, and New England states for European Americans [3,4,5,6]. Despite previous studies discussing the epidemiology and outcome of sarcoidosis, no study has evaluated the role of the state-level health disparity in mortality. We evaluated the association of sarcoidosis-related mortality, state health rankings, and numbers of sarcoidosis medical centers to provide a general overview of the relationship between mortality and health care disparities in the US. South Carolina had the highest AAMR for all populations (6.6/1,000,000) and African Americans (20.8/1,000,000)
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