Sarcoidosis in coroner's autopsies: a critical evaluation of diagnosis and prevalence from Cuyahoga County, Ohio.

BACKGROUND AND AIM OF THE WORK

During a histologic study of sarcoidosis in tissues made available from the Cuyahoga County Coroner's autopsy files, the prevalence of this disorder seemed much greater than generally reported. Aims were to evaluate this impression and if confirmed, to explore underlying reasons, including reliability of diagnoses and possible overestimates as well as possible associations with particular population subgroups.

METHODS

Cases were retrieved by computer search of diagnoses coded over the past 7 years. Extent of organ involvement was documented and relevant microscope slides reviewed, with consideration of diagnostic criteria generally proposed. Clinical information, occupational risk and evidence for illicit drug use were evaluated. Acceptable cases were categorized by gender, race and age. Crude and standardized prevalences were calculated and related to 1990 US Census figures for the County.

RESULTS

On review of 9324 adult autopsies performed for medico-legal reasons, 31 were judged to have sarcoidosis. Standardized prevalence was 320 +/- 72/10(5). Among population subgroups statistically significant differences were not established. However, crude prevalences suggested that females, blacks and younger persons were more likely to have sarcoidosis than males, whites and older subjects, with ratios of 1.6 to 1; 4.7 to 1; and 2.5 to 1, respectively. Overall prevalence was some 10 times greater than indicated from State-wide death certificates.

CONCLUSIONS

Sarcoidosis as found in cases autopsied at the/Coroner's Office, Cuyahoga County, is much more prevalent than generally reported. It is an under-appreciated cause of sudden unexpected death. Young black females appear to be most affected, and worthy of further investigation.