In-Hospital Disease Burden of Sarcoidosis in Switzerland from 2002 to 2012

Abstract

Sarcoidosis is a multisystem disease with an unpredictable and sometimes fatal course while the underlying pathomechanism is still unclear. Reasons of the increasing hospitalization rate and mortality in the United States remain in dispute but incriminated are a number of distinct comorbidities and risk factors as well as the application of more aggressive therapeutic agents. Studies reflecting the recent development in central Europe are lacking. Our aim was to investigate the recent mortality and hospitalization rates as well as the underlying comorbidities of hospitalized sarcoidosis patients in Switzerland. In this longitudinal, nested case-control study, a nation-wide database provided by the Swiss Federal Office for Statistics enclosing every hospital entry covering the years 2002–2012 (n = 15,627,573) was analyzed. There were 8,385 cases with a diagnosis of sarcoidosis representing 0.054% (8,385 / 15,627,573) of all hospitalizations in Switzerland. These cases were compared with age- and sex-matched controls without the diagnosis of sarcoidosis. Hospitalization and mortality rates in Switzerland remained stable over the observed time period. Comorbidity analysis revealed that sarcoidosis patients had significantly higher medication-related comorbidities compared to matched controls, probably due to systemic corticosteroids and immunosuppressive therapy. Sarcoidosis patients were also more frequently re-hospitalized (median annual hospitalization rate 0.28 [IQR 0.15-0.65] vs. 0.19 [IQR 0.13-0.36] per year; p < 0.001), had a longer hospital stay (6 [IQR 2-13] vs. 4 [IQR 1-8] days; p < 0.001), had more comorbidities (4 [IQR 2-7] vs. 2 [IQR 1-5]; p < 0.001), and had a significantly higher in-hospital mortality (2.6% [95% CI 2.3%-2.9%] vs. 1.8% [95% CI 1.5%-2.1%] (p < 0.001). A worse outcome was observed among sarcoidosis patients having co-occurrence of associated respiratory diseases. Moreover, age was an important risk factor for re-hospitalization.

Hospitalization Among Patients with Sarcoidosis: A Population-Based Cohort Study 1987–2015

“…In fact, one study reported that African-Americans with sarcoidosis were hospitalized 9 times more often than Caucasians with sarcoidosis [6]. The results of the current study are in line with the other predominantly Caucasian cohort from Switzerland that also did not observe a significant trend in hospitalization rates from 2002 to 2012 [7]. …”

“…Previous epidemiologic studies on trends of hospitalization among these patients have yielded conflicting results. Two coding-based studies using nationwide hospitalization samples from the U.S. found an increased rate of hospitalization among patients with sarcoidosis from 1980 to mid-2000 [5, 6] while a coding-based study from Switzerland using a national hospitalization registry reported a stable rate of hospitalization from 2002 to 2012 [7]. On the other hand, a prospective cohort study of U.S. Navy personnel demonstrated a marked decline of hospitalization for sarcoidosis from 1975 to 2001 [8].…”

Toxicity risk from glucocorticoids in sarcoidosis patients

“…Several epidemiologic studies have shown a high prevalence of comorbid diseases that may be associated with GCs in sarcoidosis populations. A case-control study analyzing 8385 Swiss patients hospitalized with sarcoidosis compared with matched nonsarcoidosis hospitalizations suggested odds ratios ranging from 2.0 to 26.3 for hypertension, diabetes and osteoporosis [19]. These findings accord with data from the Black Women's Health Study where hypertension (57%), hypercholesterolemia (47%), and Type 2 diabetes (21%) were prevalent in sarcoidosis patients [20].…”

Comprehensive Care for Patients with Sarcoidosis

“…According to one study, patients with higher cumulative doses of prednisolone had a significantly lower QoL when adjusted for disease severity [4,39]. Moreover, medication-related events lead to a substantial number of hospitalizations in patients with sarcoidosis [41]. Consequently, (dis)advantages of starting and continuing therapy should be weighted by the healthcare provider and patient during every clinic visit.…”

“…Comorbidities may also importantly impact QoL and are more prevalent in patients with sarcoidosis compared to the normal population [41,86,87]. A higher number of comorbidities is associated with more frequent hospitalizations and a higher mortality rate [87,88].…”