Study objectives: To compare the sarcoidosis mortalityin referral settings (RS) and population-based settings (PS), and toidentify the contribution of stage, ethnicity, and corticosteroidtherapy (CST) to their disparate outcomes.
Design: Allobservational studies identified in a MEDLINE search and bibliographicreview published in the English language since 1960 dealing with thecourse and prognosis of sarcoidosis in large, unsorted, adult,ambulatory RS and PS providing long-term follow-up were reviewed andsubjected to meta-analysis.
Measurements and results:Sarcoidosis mortality in RS (4.8%), in which 17% of patients had themost unfavorable prognosis as judged by stage (stage III), was 10-foldthat reported in PS (0.5%), in which 11% of patients were identifiedat this stage. The magnitude of this disparity could not be accountedfor solely by adverse selection, as indicated by stage or by ethnicity.Patients in RS received CST with sevenfold the frequency of PS, and itsprovision was highly correlated with stage-normalized mortality.
Conclusion: The prognosis of patients with intrathoracicsarcoidosis in PS is far more favorable than that obtained in RS.Sarcoidosis mortality is largely independent of ethnicity. Thepossibility cannot be excluded that excessive employment of CST mayunfavorably influence the long-term course of the disease in someindividuals.