Black, Female Patients with Sarcoidosis More Likely to be Hospitalized

A new retrospective analysis showed key sex- and race-related disparities in outcomes among patients hospitalized with sarcoidosis.¹

More pertinently, the new data presented at the Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL, this week showed Black patients are more likely to present to the hospital with sarcoidosis than other races—while men are at greater risk than women of sarcoidosis mortality.

A team of US-based investigators led by Krishna Bashyal, MD, a resident physician at McLaren Flint Hospital in Michigan, conducted a review of hospitalization trends among patients with sarcoidosis based on their race and sex. Noting that sarcoidosis has historically been linked to middle-aged African American patients—even more specifically, female patients—the team wanted to fill gaps in knowledge regarding hospitalization outcomes and differences in length of stay and mortality based on patient demographics.

Their study used data from the 2016 – 2020 iterations of the National Inpatient Sample, the largest all-payer public database regarding US hospital care. All patients with ICD-10 codes indicating a sarcoidosis diagnosis at the time of hospitalization between 2016 – 2020 were included in the analysis.

In the 5-year period of analysis, Bashyal and colleagues identified 79,827 hospitalizations with sarcoidosis. The annual rate of sarcoidosis hospitalizations trended up before decreasing in the final year of review: 224 per 100,000 hospitalizations in 2016; 226 per 100,000 in 2017; 231 per 100,000 in 2018; 234 per 100,000 in 2019; then 227 per 100,000 in 2020.

Black patients with sarcoidosis were far and away the most likely to be hospitalized—677 per 100,000 hospitalizations, versus 171 White patients per 100,000; 76 Hispanic patients per 100,000; and 54 Asian patients per 100,000. Despite the significantly greater prevalence, Black patients with sarcoidosis were generally younger than the other populations at time of hospitalization: 57.3 years, versus 64.0 years among White patients; 57.8 years among Hispanic patients and 62.2 years among Asian patients.

However, Asian patients fared worst for hospitalization outcomes. They reported a mean length of 6.2 days stay, versus 5.2 among White patients; 5.8 among Black patients; and 5.7 days among Hispanic patients. In-hospital mortality was 2636 Asian patients per 100,000, versus 2435 White patients per 100,000; 2566 Black patients per 100,000; and 2094 Hispanic patients per 100,000.

Though approximately 6 in every 10 hospitalized patients were female (61.6%), they had a significantly lower in-hospital mortality rate (2383 per 100,000) than male patients (2729 per 100,000; P = .003).

In a past episode of HCPLive’s Rare Disease Report podcast, Ennis James, MD, professor and Program Director of the Susan Pearlstine Sarcoidosis Center of Excellence at the Medical University of South Carolina, discussed how despite about 10% of sarcoidosis patients suffering from advanced disease, a notable proportion of patients are initially diagnosed incidentally.2

“We don't know what causes it,” James said. “The theory is that you get exposed to something in the environment that triggers an abnormal response in the immune system. It's historically been a difficult disease to manage because it can present in so many different ways.”

Bashyal and colleagues’ findings may at least elucidate how patient demographics may incline risk of advanced disease and mortality in hospitalization.

References

1. ^{Bashyal K, Balmuri S, Baral N, Ghitmire C, et al. Sex and race-based differences in hospitalization trends in patients with Sarcoidosis. Paper presented at: Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting. Destin, FL. May 4 – 7, 2023.}
2. ^{Alicea J. The Rare Disease Report Podcast: Sarcoidosis. HCPLive. Published April 19, 2021. https://www.hcplive.com/view/rare-disease-report-sarcoidosis}