Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

In This Article


Sarcoidosis affects people of all races, all ages, and both males and females. It is most prevalent in African American, Afro-Caribbean, Swedish, and Danish individuals. It is rarely reported in Spain, Portugal, India, Saudi Arabia, or South America because of the absence of mass screening programs and the prevalence of more commonly recognized granulomatous diseases such as tuberculosis, fungal infections, and Hansen's disease.[1]

It is important to note whether incidence or prevalence data are derived from general population-based, hospital record-based, mass radiography-based or sarcoidosis registration-based data. Since asymptomatic cases may be detected by chest x-rays showing bilateral hilar adenopathy, the best studies are based on a sarcoidosis registration system that includes cases detected by mass radiographic screening and those detected by symptoms. In a Swedish study done from 1966 to 1980, a total of 57% of the cases were detected by mass chest radiographs. In a 1972 Japanese survey, a 50% prevalence rate of asymptomatic cases was reported.[3]

A mortality study in the United States using death certificates, conducted from 1979 to 1991, found that the annual mortality rate was highest in African American females, especially those aged 45-54 years.[4]

Sarcoidosis was listed as the cause of death in 64.2% of the 9014 death records, similar to the 60.6% of 320 deaths in a Japanese study,[5] except for the fact that 77% of Japanese deaths were due to cardiac complications of sarcoidosis. In contrast, a US-based study found that 87% of these deaths were due to pulmonary complications.[6]

Researchers at the Cuyahoga county coroner's office in Ohio reviewed 9324 autopsies done between 1990 and 1997 and found a standardized prevalence of 320 ± 72 per 100,000. Crude prevalence rates suggested young black females were most affected, and overall prevalence was 10 times greater than state-wide death certificates indicated.[7] This study suggests sarcoidosis is more prevalent than reported and is an underrecognized cause of unexpected death, especially in young African American women. Autopsy studies, however, may not be representative of patients with sarcoidosis because of the prevalence of spontaneous resolution; absence of detailed occupational, social, and past medical histories; and the less than 5% mortality rate in sarcoidosis.

In the only population-based incidence study of sarcoidosis in the United States, the age-adjusted annual incidence was 35.5 per 100,000 for black individuals and 10.9 per 100,000 for white individuals, 5.9 per 100,000 person years for men and 6.3 per 100,000 person years for women.[8] Using cumulative incidence estimates, the lifetime risk of sarcoidosis is 0.85% for white individuals and 2.4% for black individuals in the United States.[9]


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