Sarcoidosis: An Ill-afforded Disease

Abstract

Sarcoidosis is a systemic inflammatory disorder of unknown origin. Its clinical course ranges from asymptomatic disease with spontaneous remission to chronic illness resulting in significant organ impairment and even death (1). Socioeconomic status (SES) refers broadly to the "standing or class of an individual or group," typically measured singularly or as a composite of income, educational level, occupational class, wealth, and race (2). Throughout history, SES has been linked to differences in morbidity and mortality for nearly every known illness, with those of greater means generally enjoying better overall health than those in lower strata (3). With few exceptions, SES has been associated with sarcoidosis risk. In the ACCESS (A Case Control Etiologic Study of Sarcoidosis) study, black race and low income were each associated with greater disease severity at presentation (4). Mining, construction, and agricultural occupations have been associated with up to fourfold increases in sarcoidosis risk (5, 6), and increased risk of sarcoidosis and "sarcoid-like" disease have been described in firefighters and 9/11 firstresponders (7). What is less clear are the mechanisms by which sarcoidosis effects SES. Previous studies have found that subjects with sarcoidosis experienced more illness-related sick days annually than those without sarcoidosis (8) and that sarcoidosis-related disability persisted for more than 5 years after diagnosis (9). In this issue of the Journal, Harper and colleagues (pp. 955-964) further evaluate the relationship between household income and disease trajectory in a registry-based cohort of cases enrolled in the Foundation for Sarcoidosis Research-Sarcoidosis Advanced Registry for Cures (FSR_SARC) database (10, 11). Among their findings, they report that low-SES patients-defined as self-reported household income of ,$35,000-had greatest negative impact on their financial status, and worse long-term outcomes, including steroid-associated illness. Multiple factors mediate the effect of sarcoidosis on SES. An analysis of the Optum Healthcare database estimated the average individual cost of care for sarcoidosis to be in excess of $32,000 annually, with the top 5% of patients incurring costs exceeding $93,000 (12). Previous studies show that patients with "high-cost" sarcoidosis are more likely to receive care in the emergency department, be on prednisone (8), and experience more severe disease (13). These costs disproportionately affect patients with lower income, and economic recovery can be difficult because of sizable medical debt. In the years after the passage of the Affordable Care Act, approximately 67% of all bankruptcies

Global trends of interstitial lung diseases from 1990 to 2019: an age–period–cohort study based on the Global Burden of Disease study 2019, and projections until 2030

“…Diagnostic tools such as computed tomography and multidisciplinary discussions are crucial for the diagnosis of ILD ( 28 ). Low income was correlated with a higher risk of comorbidities and adverse outcomes in patients with sarcoidosis ( 29 ). The availability and accessibility of abundant medical resources in high-SDI regions contributed to the diagnosis of ILD and perhaps led to the highest prevalence rate.…”