San Francisco Veterans Affairs Medical Center, San Francisco, California.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine.
Ann Am Thorac Soc. 2023 Jun;20(6):797-806. doi: 10.1513/AnnalsATS.202206-515OC.
United States veterans represent an important population to study sarcoidosis. Their unique history of environmental exposures, wide geographic distribution, and long-term enrollment in a single integrated healthcare system provides an unparalleled opportunity to understand the incidence, prevalence, and risk factors for sarcoidosis. To determine the epidemiology, patient characteristics, geographic distribution, and associated risk factors of sarcoidosis among U.S. veterans. We used data from the Veterans Health Administration (VHA) electronic health record system between 2003 and 2019 to evaluate the annual incidence, prevalence, and geographic distribution of sarcoidosis (defined using the International Classification of Diseases codes). We used multivariate logistic regression to examine patient characteristics associated with sarcoidosis incidence. Among more than 13 million veterans who received care through or paid for by the VHA, 23,747 (0.20%) incident diagnoses of sarcoidosis were identified. Compared with selected VHA control subjects using propensity score matching, veterans with sarcoidosis were more likely to be female (13.5% vs. 9.0%), of Black race (52.2% vs. 17.0%), and ever-tobacco users (74.2% vs. 64.5%). There was an increase in the annual incidence of sarcoidosis between 2004 and 2019 (from 38 to 52 cases/100,000 person-years) and the annual prevalence between 2003 and 2019 (from 79 to 141 cases/100,000 persons). In a multivariate logistic regression model, Black race (odds ratio [OR], 4.49; 95% confidence interval [CI], 4.33-4.65), female sex (OR, 1.64; 95% CI, 1.56-1.73), living in the Northeast compared with the western region (OR, 1.57; 95% CI, 1.48-1.67), history of tobacco use (OR, 1.36; 95% CI, 1.31-1.41), and serving in the Army, Air Force, or multiple branches compared with the Navy (OR, 1.08; 95% CI, 1.03-1.13; OR, 1.10; 95% CI, 1.04-1.17; OR, 1.27; 95% CI, 1.16-1.39, respectively) were significantly associated with incident sarcoidosis ( < 0.0001). The incidence and prevalence of sarcoidosis are higher among veterans than in the general population. Alongside traditionally recognized risk factors such as Black race and female sex, we found that a history of tobacco use within the Veterans Affairs population and serving in the Army, Air Force, or multiple service branches were associated with increased sarcoidosis risk.
美国退伍军人是研究结节病的一个重要人群。他们独特的环境暴露史、广泛的地理分布以及长期在单一的综合医疗系统中接受治疗，为了解结节病的发病率、患病率和风险因素提供了无与伦比的机会。为了确定美国退伍军人中结节病的流行病学、患者特征、地理分布和相关风险因素。我们使用了退伍军人健康管理局（VHA）电子健康记录系统在 2003 年至 2019 年期间的数据，评估了结节病的年发病率、患病率和地理分布（使用国际疾病分类代码定义）。我们使用多变量逻辑回归来检查与结节病发病率相关的患者特征。在接受 VHA 护理或 VHA 付费的超过 1300 万退伍军人中，确定了 23747 例（0.20%）结节病的新发诊断。与使用倾向评分匹配的选定 VHA 对照相比，患有结节病的退伍军人更可能为女性（13.5%比 9.0%），为黑人（52.2%比 17.0%），且曾吸烟（74.2%比 64.5%）。2004 年至 2019 年期间，结节病的年发病率（从 38 例/10 万人年增加到 52 例/10 万人年）和 2003 年至 2019 年期间的年患病率（从 79 例/10 万人增加到 141 例/10 万人）均有所增加。在多变量逻辑回归模型中，黑人（比值比[OR]，4.49；95%置信区间[CI]，4.33-4.65）、女性（OR，1.64；95%CI，1.56-1.73）、与西部地区相比居住在东北部（OR，1.57；95%CI，1.48-1.67）、有吸烟史（OR，1.36；95%CI，1.31-1.41）、与海军相比，曾在陆军、空军或多个分支机构服役（OR，1.08；95%CI，1.03-1.13；OR，1.10；95%CI，1.04-1.17；OR，1.27；95%CI，1.16-1.39，分别）与结节病的发病显著相关（<0.0001）。退伍军人中结节病的发病率和患病率高于普通人群。除了传统上公认的风险因素，如黑人和女性，我们发现退伍军人中吸烟史和在陆军、空军或多个军种服役与结节病风险增加有关。
