From the Division of Pulmonary, Critical Care, Sleep and Allergy (Drs Mirsaeidi, Machado, and Schraufnagel), Department of Medicine, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System (Dr Sweiss); and the Interstitial Lung Disease and Sarcoidosis Clinic (Dr Baughman), Department of Internal Medicine, University of Cincinnati Medical Center.
CORRESPONDENCE TO: Mehdi Mirsaeidi, MD, MPH, Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, 840 S Wood St (MC 719), Room 920-N CSB, Chicago, IL 60612-7323; e-mail: firstname.lastname@example.org
FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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Fatality rate should not be confused with mortality rate. Case mortality rate defines the proportion of people who die of a certain disease; however, mortality rate is the death rate in an entire population. Our study was not designed to find the racial difference in fatality rates.1
Assuming equal case fatality for African American (AA) and Caucasian patients with sarcoidosis may not be correct. Sarcoidosis among AAs is usually more symptomatic. They experience more extensive pulmonary disease and a greater need for lung transplant.2,3 Therefore, assuming equal case fatality for AAs and Caucasians is doubtful.
The statement of a higher fatality rate in tertiary care settings because of corticosteroid therapy use may lead to significant misunderstanding about the role of steroids in current sarcoidosis treatment. The reason for higher fatality rates associated with sarcoidosis could be related to more severe patients being treated in tertiary centers.
Regarding Dr Reich’s concern about the study by Rybicki et al4 (Reference 4 in our article), we disagree with Dr Reich about any inconsistent incidence results in the study. Cragin et al5 reported a statewide prevalence of sarcoidosis in Vermont. They showed that Vermont had a high prevalence of disease (66 in 100,000 population). Therefore, a high mortality rate for this state would not be surprising.
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