BACKGROUND Sarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. RESEARCH QUESTIONS What are the trends in all-cause mortality among U.S. Veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs. White racial disparities, and geographic variability in relation to mortality? STUDY DESIGN AND METHODS Using Veterans Health Administration (VHA) electronic health records (EHR), we conducted a population-based, retrospective cohort study of adjusted all-cause mortality 2004-2022 among Veterans diagnosed with sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015-2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI). RESULTS In all, 23,745 Veterans were diagnosed with sarcoidosis between 2004 and 2019 and followed through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P<0.0001) and was 6.4% higher in Black than White Veterans (mortality rate ratio=1.064, P=0.02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, and Northeast residence, and lower risk with "Other" service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged. INTERPRETATION Mortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.

中文翻译：

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2004-2022 年患有结节病的美国退伍军人全因死亡率趋势。


背景 结节病是一种特发性多器官疾病，临床结果各不相同。缺乏对美国退伍军人结节病死亡率的全面分析。研究问题 患有结节病的美国退伍军人全因死亡率的趋势是什么，这些趋势如何受到人口统计学、黑人与白人的种族差异以及与死亡率相关的地理差异的影响？研究设计和方法 使用退伍军人健康管理局 （VHA） 电子健康记录 （EHR），我们对 2004-2022 年通过 VHA 接受护理的被诊断患有结节病的退伍军人进行了 2004-2022 年调整后全因死亡率的回顾性队列研究。人口统计学、居住地区、服务分支、烟草使用和合并症从 EHR 中提取。使用多变量未分组泊松回归检查全因死亡率的年度趋势和与死亡率相关的患者水平特征。我们可视化了趋势并使用边际均值程序分析了各州的死亡率。在亚组分析 （2015-2022） 中，我们使用面积剥夺指数 （ADI） 考虑了社区层面社会经济差异的影响。结果在 2004 年至 2019 年期间，共有 23,745 名退伍军人被诊断出患有结节病，并一直随访到 2022 年。调整后，包括年龄和性别，全因死亡率每年增加 4.7% （P<0.0001），黑人退伍军人比白人退伍军人高 6.4% （死亡率比 =1.064，P=0.02）。比较有和没有 ADI 调整的模型的亚组分析显示死亡率趋势没有有意义的变化。全因死亡率增加的危险因素包括高龄、男性、黑人种族和东北部居住地，以及“其他”服务分支的风险较低。 尽管死亡率存在不同的地理差异，但没有出现明确的模式。解释 患有结节病的退伍军人的死亡率正在上升。按服务部门确定的差异和男性退伍军人之间的较高风险引发了对环境暴露差异的质疑。与其他研究相比，ADI 的种族差异更小，影响更小，这可能突出了全民医疗保健可及性在实现公平结果方面的作用。