Increased hospitalizations among sarcoidosis patients from 1998 to 2008: a population-based cohort study

BMC Pulmonary Medicine

Philip M Polgreen²  Joseph E Cavanaugh¹  Fan Tang¹  Ming Yang¹  Alicia K Gerke² 

[1]Department of Biostatistics, University of Iowa, 105 River Street, Iowa City, IA, 52242, USA

[2]Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA

关键词: Trends;    Outcomes;    Hospitalizations;    Epidemiology;    Sarcoidosis;   

Others  :  1172474
DOI  :  10.1186/1471-2466-12-19

 received in 2011-06-02, accepted in 2012-05-14,  发布年份 2012

【 摘 要 】

Background

Diagnostic and treatment approaches for sarcoidosis have changed dramatically over the past decade. Yet, the most recent reports of trends in hospitalizations of sarcoidosis patients are over ten years old. The objectives of this study were to determine the incidence of sarcoidosis among hospitalized patients and to analyze recent trends and seasonality of hospitalizations in sarcoidosis patients.

Methods

We performed a retrospective cohort study of the Nationwide Inpatient Sample from 1998 through 2008. We identified all hospitalizations with a primary or secondary diagnosis of sarcoidosis (ICD-9-CM code 135). Incidence was modeled as a seasonal time series about a linear trend.

Results

Time series analysis of the monthly number of hospitalizations revealed a distinct positive linear trend. Over the study period, the number of hospitalized patients with sarcoidosis increased from 37,516 to 70,947 cases. Trends were most pronounced in patients older than 55 years (p < 0.0001), African Americans (p < 0.0001), females (p = 0.0289), and non-Medicaid populations (p < 0.0001). Hospitalizations are seasonal with highest incidence in January through March.

Conclusions

Hospitalizations among sarcoidosis patients have almost doubled during the past decade, with disproportionate rate increases in African Americans, women, and older patients. The rate also increases among patients with insurance other than Medicaid. This study indicates the need for heightened surveillance of sarcoidosis patients given the unknown consequences of evolving treatment approaches. Our results point to a need for research investigating risk factors for hospitalization, including medications, co-morbidities, demographics, and socioeconomic status.

【 授权许可】

   
2012 Gerke et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Chen ES, Moller DR: Etiology of sarcoidosis. Clin Chest Med 2008, 29:365-377.
• [2]Statement on sarcoidosis: Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999, 160:736-755.
• [3]Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R: Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001, 164:1885-1889.
• [4]Westney GE, Judson MA: Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics. Clin Chest Med 2006, 27:453-462.
• [5]Gorham ED, Garland CF, Garland FC, Kaiser K, Travis WD, Centeno JA: Trends and occupational associations in incidence of hospitalized pulmonary sarcoidosis and other lung diseases in Navy personnel: a 27-year historical prospective study, 1975–2001. Chest 2004, 126:1431-1438.
• [6]Foreman MG, Mannino DM, Kamugisha L, Westney GE: Hospitalization for patients with sarcoidosis: 1979–2000. Sarcoidosis Vasc Diffuse Lung Dis 2006, 23:124-129.
• [7]Baughman RP, Lower EE: Novel therapies for sarcoidosis. Semin Respir Crit Care Med 2007, 28:128-133.
• [8]Balan A, Hoey ET, Sheerin F, Lakkaraju A, Chowdhury FU: Multi-technique imaging of sarcoidosis. Clin Radiol 2010, 65:750-760.
• [9]Muller-Quernheim J, Kienast K, Held M, Pfeifer S, Costabel U: Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J 1999, 14:1117-1122.
• [10]Baughman RP, Winget DB, Lower EE: Methotrexate is steroid sparing in acute sarcoidosis: results of a double blind, randomized trial. Sarcoidosis Vasc Diffuse Lung Dis 2000, 17:60-66.
• [11]Judson MA, Baughman RP, Costabel U, Flavin S, Lo KH, Kavuru MS, Drent M: Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J 2008, 31:1189-1196.
• [12]Rossman MD, Newman LS, Baughman RP, Teirstein A, Weinberger SE, Miller W, Sands BE: A double-blinded, randomized, placebo-controlled trial of infliximab in subjects with active pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2006, 23:201-208.
• [13]Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, du Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Muller-Quernheim J, Schlender-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES: Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006, 174:795-802.
• [14]Swigris JJ, Olson AL, Huie TJ, Fernandez-Perez ER, Solomon J, Sprunger D, Brown KK: Sarcoidosis-related Mortality in the U.S. from 1988–2007. Am J Respir Crit Care Med 2011, 183:1524-1530.
• [15]Agency for Healthcare Research and Quality: [http://www.hcup-us.ahrq.gov/nisoverview.jsp] webciteOverview of the Nationwide Inpatient Sample (NIS). 2009.
• [16]Rybicki BA, Major M, Popovich J, Maliarik MJ, Iannuzzi MC: Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 1997, 145:234-241.
• [17]James DG, Neville E, Siltzbach LE: A worldwide review of sarcoidosis. Ann N Y Acad Sci 1976, 278:321-334.
• [18]Henke CE, Henke G, Elveback LR, Beard CM, Ballard DJ, Kurland LT: The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival. Am J Epidemiol 1986, 123:840-845.
• [19]Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC: Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med 1996, 335:791-799.
• [20]Chang B, Steimel J, Moller DR, Baughman RP, Judson MA, Yeager H, Teirstein AS, Rossman MD, Rand CS: Depression in sarcoidosis. Am J Respir Crit Care Med 2001, 163:329-334.
• [21]Rabin DL, Thompson B, Brown KM, Judson MA, Huang X, Lackland DT, Knatterud GL, Yeager H, Rose C, Steimel J: Sarcoidosis: social predictors of severity at presentation. Eur Respir J 2004, 24:601-608.
• [22]Ligon CB, Judson MA: Impact of systemic corticosteroids on healthcare utilization in pateints with sarcoidosis. Am J Med Sci 2011, 341:196-201.
• [23]Nguyen GC, Tuskey A, Dassopoulos T, Harris ML, Brant SR: Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004. Inflamm Bowel Dis 2007, 13:1529-1535.
• [24]Cannom RR, Kaiser AM, Ault GT, Beart RW, Etzioni DA: Inflammatory bowel disease in the United States from 1998 to 2005: has infliximab affected surgical rates? Am Surg 2009, 75:1039-1045.
• [25]Demirkok SS, Basaranoglu M, Akbilgic O: Seasonal variation of the onset of presentations in stage 1 sarcoidosis. Int J Clin Pract 2006, 60:1443-1450.
• [26]Wilsher ML: Seasonal clustering of sarcoidosis presenting with erythema nodosum. Eur Respir J 1998, 12:1197-1199.
• [27]Gribbin J, Hubbard RB, Le Jeune I, Smith CJ, West J, Tata LJ: Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK. Thorax 2006, 61:980-985.
• [28]Gillman A, Steinfort C: Sarcoidosis in Australia. Intern Med J 2007, 37:356-359.