Original Research| Volume 187, 106564, October 2021

The impact of demographic disparities in the presentation of sarcoidosis: A multicenter prospective study

Published:August 08, 2021DOI:


      • It is an international study with large cohort of patients with sarcoidosis.
      • Organ involvement and treatment differed according to race, sex, and age.
      • Black and female individuals were more likely to have multiple organ involvement.
      • Age at diagnosis<45, Black patients and multiple organ involvement were independent predictors of treatment.



      To study how demographic differences impact disease manifestation of sarcoidosis using the WASOG tool in a large multicentric study.


      Clinical data regarding 1445 patients with sarcoidosis from 14 clinical sites in 10 countries were prospectively reviewed from Feb 1, 2020 to Sep 30, 2020. Organ involvement was evaluated for the whole group and for subgroups differentiated by sex, race, and age.


      The median age of the patients at diagnosis was 46 years old; 60.8% of the patients were female. The most commonly involved organ was lung (96%), followed by skin (24%) and eye (22%). Black patients had more multiple organ involvement than White patients (OR = 3.227, 95% CI: 2.243–4.643) and females had more multiple organ involvement than males (OR = 1.238, 95% CI: 1.083–1.415). Black patients had more frequent involvement of neurologic, skin, eye, extra thoracic lymph node, liver and spleen than White and Asian patients. Women were more likely to have eye (OR = 1.522, 95%CI: 1.259–1.838) or skin involvement (OR = 1.369, 95%CI: 1.152–1.628). Men were more likely to have cardiac involvement (OR = 1.326, 95%CI: 1.096–1.605). A total of 262 (18.1%) patients did not receive systemic treatment for sarcoidosis. Therapy was more common in Black patients than in other races.


      The initial presentation and treatment of sarcoidosis was related to sex, race, and age. Black and female individuals are found to have multiple organ involvement more frequently. Age at diagnosis<45, Black patients and multiple organ involvement were independent predictors of treatment.


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        • Statement on sarcoidosis
        Joint statement of the American thoracic society (ATS), the European respiratory society (ERS) and the world association of sarcoidosis and other granulomatous disorders (WASOG) adopted by the ATS board of directors and by the ERS executive committee.
        Am. J. Respir. Crit. Care Med. 1999; 160: 736-755
        • Valeyre D.
        • et al.
        Sarcoidosis. Lancet. 2014; 383: 1155-1167
        • Westney G.E.
        • Judson M.A.
        Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics.
        Clin. Chest Med. 2006; 27: 453-462
        • Baughman R.P.
        • et al.
        Clinical characteristics of patients in a case control study of sarcoidosis.
        Am. J. Respir. Crit. Care Med. 2001; 164: 1885-1889
        • Judson M.A.
        • Boan A.D.
        • Lackland D.T.
        The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States.
        Sarcoidosis Vasc. Diffuse Lung Dis. 2012; 29: 119-127
        • Cozier Y.C.
        • et al.
        Sarcoidosis in black women in the United States: data from the black women's Health study.
        Chest. 2011; 139: 144-150
        • Judson M.A.
        • et al.
        Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS research group. A case control etiologic study of sarcoidosis.
        Sarcoidosis Vasc. Diffuse Lung Dis. 1999; 16: 75-86
        • Judson M.A.
        • et al.
        The WASOG Sarcoidosis Organ Assessment Instrument: an update of a previous clinical tool.
        Sarcoidosis Vasc. Diffuse Lung Dis. 2014; 31: 19-27
        • Izumi T.
        Symposium: population differences in clinical features and prognosis of sarcoidosis throughout the world.
        Sarcoidosis. 1992; 9: S105-S118
        • Siltzbach L.E.
        • et al.
        Course and prognosis of sarcoidosis around the world.
        Am. J. Med. 1974; 57: 847-852
        • Harris P.A.
        • et al.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J. Biomed. Inf. 2009; 42: 377-381
        • Arkema E.V.
        • et al.
        Sarcoidosis incidence and prevalence: a nationwide register-based assessment in Sweden.
        Eur. Respir. J. 2016; 48: 1690-1699
        • Baughman R.P.
        • et al.
        Sarcoidosis in America. Analysis based on Health care use.
        Ann Am Thorac Soc. 2016; 13: 1244-1252
        • Kowalska M.
        • Niewiadomska E.
        • Zejda J.E.
        Epidemiology of sarcoidosis recorded in 2006-2010 in the Silesian voivodeship on the basis of routine medical reporting.
        Ann. Agric. Environ. Med. 2014; 21: 55-58
        • Ungprasert P.
        • et al.
        Clinical characteristics of ocular sarcoidosis: a population-based study 1976-2013.
        Ocul. Immunol. Inflamm. 2019; 27: 389-395
        • Ying Z.
        • et al.
        Clinical characteristics of sarcoidosis patients in the United States versus China.
        Sarcoidosis Vasc. Diffuse Lung Dis. 2017; 34: 209-216
        • Birnbaum A.D.
        • et al.
        Sarcoidosis in the national veteran population: association of ocular inflammation and mortality.
        Ophthalmology. 2015; 122: 934-938
        • James W.E.
        • et al.
        Clinical features of extrapulmonary sarcoidosis without lung involvement.
        Chest. 2018; 154: 349-356
        • Morimoto T.
        • et al.
        Epidemiology of sarcoidosis in Japan.
        Eur. Respir. J. 2008; 31: 372-379
        • Yanardag H.
        • Pamuk O.N.
        • Karayel T.
        Cutaneous involvement in sarcoidosis: analysis of the features in 170 patients.
        Respir. Med. 2003; 97: 978-982
        • Martusewicz-Boros M.M.
        • et al.
        Cardiac sarcoidosis: is it more common in men?.
        Lung. 2016; 194: 61-66
        • Baughman R.P.
        • Lower E.E.
        • Kaufman A.H.
        Ocular sarcoidosis.
        Semin. Respir. Crit. Care Med. 2010; 31: 452-462
        • Rabin D.L.
        • et al.
        Sarcoidosis: social predictors of severity at presentation.
        Eur. Respir. J. 2004; 24: 601-608
        • Judson M.A.
        An approach to the treatment of pulmonary sarcoidosis with corticosteroids: the six phases of treatment.
        Chest. 1999; 115: 1158-1165
        • Sharma O.P.
        Pulmonary sarcoidosis and corticosteroids.
        Am. Rev. Respir. Dis. 1993; 147: 1598-1600
        • Baughman R.P.
        • et al.
        Presenting characteristics as predictors of duration of treatment in sarcoidosis.
        QJM. 2006; 99: 307-315
        • Rahaghi F.F.
        • et al.
        Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis.
        Eur. Respir. Rev. 2020; 29
        • Paramothayan N.S.
        • Lasserson T.J.
        • Jones P.W.
        Corticosteroids for pulmonary sarcoidosis.
        Cochrane Database Syst. Rev. 2005; (p. CD001114)
        • Baughman R.P.
        • Winget D.B.
        • Lower E.E.
        Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial.
        Sarcoidosis Vasc. Diffuse Lung Dis. 2000; 17: 60-66
        • Vorselaars A.
        • et al.
        Methotrexate vs azathioprine in second-line therapy of sarcoidosis.
        Chest. 2013; 144: 805-812
        • Majithia V.
        • et al.
        Successful treatment of sarcoidosis with leflunomide.
        Rheumatology. 2003; 42: 700-702
        • Cremers J.P.
        • et al.
        Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide.
        Curr. Opin. Pulm. Med. 2013; 19: 545-561
        • Baughman R.
        • Cremers J.P.
        • Harmon M.
        Methotrexate in sarcoidosis: hematologic and hepatic toxicity encountered in a large cohort over a six year period.
        Sarcoidosis Vasc. Diffuse Lung Dis. 2020; 37: c2020001
        • Lower E.E.
        • Baughman R.P.
        Prolonged use of methotrexate for sarcoidosis.
        Arch. Intern. Med. 1995; 155: 846-851
        • Judson M.A.
        • et al.
        Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial.
        Eur. Respir. J. 2008; 31: 1189-1196
        • Kamphuis L.S.
        • et al.
        Efficacy of adalimumab in chronically active and symptomatic patients with sarcoidosis.
        Am. J. Respir. Crit. Care Med. 2011; 184: 1214-1216
        • Baughman R.P.
        • et al.
        Repository corticotropin for chronic pulmonary sarcoidosis.
        Lung. 2017; 195: 313-322