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

FUNDING/SUPPORT: This research was support by grants from the National Heart, Lung, and Blood Institute (1U01 HL112695 and 1R01 HL114587-A1).

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

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, School of Medicine, University of Colorado, Denver, CO

fEnvironmental and Occupational Health, Colorado School of Public Health, University of Colorado, Denver, 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(6):1423-1424. doi:10.1016/j.chest.2016.10.004
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We appreciate Dr Reich’s careful review and positive and carefully thought-out comments about our study, its design, and analysis recently published in CHEST (August 2016). The study we undertook used a novel dataset to determine an association between sarcoidosis and more severe forms of sarcoidosis (death) and occupation; the intent of our study was never to propose a causal relationship because this conclusion is not possible with a case-control study like ours. However, we did confirm a number of prior associations noted between occupation and sarcoidosis (eg, such as some of those found in the National Institutes of Health’s A Case Control Etiologic Study of Sarcoidosis [ACCESS] study). We did find some differences from prior studies and acknowledged that these findings could be due to some of the limitations in using this dataset. These limitations include the fact that not all occupations were known, that other confounders may have existed (eg, exposures outside of work or in the workplace), and the fact that we did not have information on the temporality of exposures and disease onset, to name a few. Finally, it was our hope to help support and provide potential hypothesis-generating data that could build on our findings to evaluate exposures and antigens that may be triggers for sarcoidosis in future studies, beyond the scope of our dataset.

References

Liu H. .Patel D. .Welch A.M. .et al Association between occupational exposures and sarcoidosis: an analysis from death certificates in the United States, 1988-1999. Chest. 2016;150:289-298 [PubMed]journal. [CrossRef] [PubMed]
 
Newman L.S. .Mroz M.M. .Balkissoon R. .Maier L.A. . Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med. 2005;171:54-60 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Liu H. .Patel D. .Welch A.M. .et al Association between occupational exposures and sarcoidosis: an analysis from death certificates in the United States, 1988-1999. Chest. 2016;150:289-298 [PubMed]journal. [CrossRef] [PubMed]
 
Newman L.S. .Mroz M.M. .Balkissoon R. .Maier L.A. . Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med. 2005;171:54-60 [PubMed]journal. [CrossRef] [PubMed]
 
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