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Original Research: Diffuse Lung Disease |

Association Between Occupational Exposures and Sarcoidosis: An Analysis From Death Certificates in the United States, 1988-1999

Hongbo Liu, MD, PhD; Divya Patel, MD; Alison M. Welch, CIH; Carla Wilson, MS; Margaret M. Mroz, MSPH; Li Li, MD, PhD; Cecile S. Rose, MD, MPH; Michael Van Dyke, PhD, CIH; Jeffrey J. Swigris, DO, MS; Nabeel Hamzeh, MD; Lisa A. Maier, MD, MSPH, FCCP
Author and Funding Information

FUNDING/SUPPORT: This study was supported by the National Heart, Lung, and Blood Institute [grants 1U01 HL112695 and 1R01 HL114587-A1].

aDivision of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO

bDepartment of Biostatistics, National Jewish Health, Denver, CO

cPulmonary Division, National Jewish Health, Denver, CO

dDepartment of Epidemiology and Biostatistics, China Medical University, Shenyang, China

eDivision of Pulmonary and Critical Care Sciences, Colorado School of Public Health, University of Colorado, Aurora, CO

fSchool of Medicine, and Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO

gDivision of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL

CORRESPONDENCE TO: Lisa A. Maier, MD, MSPH, FCCP, Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson St, Denver, CO 80206


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):289-298. doi:10.1016/j.chest.2016.01.020
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Background  Sarcoidosis is a disease that is associated with occupational and environmental antigens, in the setting of a susceptible host. The aim of this study was to examine the association between sarcoidosis mortality and previously reported occupational exposures based on sex and race.

Methods  The decedents enrolled in this study were derived from United States death certificates from 1988-1999. Cause of death was coded according to ICD-9 and ICD-10. The usual occupation was coded with Bureau of the Census Occupation Codes. Mortality odds ratio (MOR) were determined and multiple Poisson regression were performed to evaluate the independent exposure effects after adjustment for age, sex, race and other occupational exposures.

Results  Of the 7,118,535 decedents in our study, 3,393 were identified as sarcoidosis-related, including 1,579 identified as sarcoidosis being the underlying cause of death. The sarcoidosis-related MOR of any occupational exposure was 1.52 (95% CI, 1.35-1.71). Women with any exposure demonstrated an increased MOR compared to women without (MOR 1.65, 95% CI, 1.45-1.89). The mortality risk was significantly elevated in those with employment involving metal working, health care, teaching, sales, banking, and administration. Higher sarcoidosis-related mortality risks associated with specific exposures were noted in women vs men and blacks vs whites.

Conclusions  Findings of prior occupations and risk of sarcoidosis were verified using sarcoidosis mortality rates. There were significant differences in risk for sarcoidosis mortality by occupational exposures based on sex and race.

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